Follow-up ultrasound of head and neck cancer

Abstract

In Germany high-resolution sonography using the color duplex mode in addition to computed tomography (CT) is a well-established and proven method in the context of restaging after primary therapy of head and neck squamous cell cancer (HNSCC). There are no international evidence-based restaging guidelines. Decisions concerning neck dissection (ND) after primary radiochemotherapy (RCT) are often individually derived in the respective tumor conferences and are therefore subject to variance. Compared to the UK or USA, in Germany there is a high level of expertise in the use of ultrasound in combination with CT for the routine restaging of HNSCC after RCT. Using high-resolution sonography (B-mode and color duplex) morphological changes in neck lymph nodes can be clearly detected. Another important aspect in the field of sonographic follow-up is the accurate and standardized documentation of findings and control of dynamic changes during follow-up. In summary, clinical presentation and sonography enable therapeutic decisions and treatment from one source.

Structured reporting of head and neck ultrasound examinations

“…Head and neck ultrasound examinations are the clinical standard in routine outpatient examinations for various neck pathologies, including follow-ups for head and neck cancer patients and surgical planning [21–23, 32]. Besides a thorough examination, accurate reporting plays an important role in ensuring the highest standards in diagnostics and therapy.…”

“…However, especially clinical examinations that follow a clearly defined workflow do benefit from a more structured approach to reporting. This includes ultrasound exams of the head and neck for evaluation of cervical lymphadenopathy, salivary gland disorders and head and neck cancer [21–23]. Additionally, there is a general lack of guidance in the use of technical terms and report structure in this field, leading to great variability in report content [1, 24].…”

Impact of structured reporting on developing head and neck ultrasound skills

“…Consequently, SRs have a great potential for diagnostic modalities that follow a standardized workflow. This includes head and neck ultrasound examinations, the gold standard for routine outpatient diagnostics of various pathologies [15–20]. Due to frequent use within follow-ups, precise and comparable reports are of central importance [21].…”

“…A frequently criticized aspect of structured reporting is that it may be too rigid and adaptations may turn out unprecise and also not time-efficient [6, 26]. This is emphasized by the complexity of the examination, the high level of work routine and the great number of structures that have to be examined for various disorders such as head and neck cancer, carotid artery stenosis and thyroid diseases [15, 16, 20].…”

Stellenwert der Bildgebung für das Re-Staging von Halslymphknotenmetastasen nach primärer Strahlentherapie − HN-Onkoimage-1

“…Aktuelle Studien zeigen jedoch, dass sowohl CT als auch MRT keine adäquate Bildgebung zur Evaluation des Lymphknotenstatus nach RCT darstellen. Tracer wird i. d. R 18. F-Fluordesoxyglukose ( 18 F-FDG, kurz FDG) verwendet.…”