Title: Lymph Node Staging in Patients of Head & Neck Malignancies with Clinically Negative Neck Examinations by Ultrasound and Ultrasound Guided Aspiration Cytology
Authors: Sunil Kumar, HP Singh, Veerendra Verma, SP Agarwal, A Mishra, Neera Kohli, M Srivastava
DOI: http://dx.doi.org/10.18535/jmscr/v4i4.04
Head and neck cancer is very common with incidence rates varying from 10-15% in various sociodemographic regions and approximately 50% of all malignant tumours in males in India. More than 90% of head neck cancers are squamous cell carcinomas with variety of malignant tumours. Clinical examination (Palpation) can miss the detection of lymph nodes in up to 60% of cases. In head and neck cancers, spread to the lymph nodes in the neck is relatively common and most important factor in determining the survival of patients with head neck cancer at any site depends on the metastatic disease in the neck. Size of lymph node is about 2-3 mm which normally can’t be palpated. High resolution ultrasound can detect these nodes which are clinically not palpable and is non-invasive harmless procedure. Because of safety of ultrasound and ultrasound guided FNAC, the procedure is likely to be used in every patient of head neck malignancies, more wide spread use would result in better planning for management of metastatic lymph nodes of neck and better care of patient by decreasing the morbidity, mortality and cost associated with unnecessary surgery by avoiding the need for other diagnostic procedures. So it is suggested that in every patient of head and neck malignancy after clinical examination ultrasound with and /or without FNAC should be done as a mandatory procedure for the better management of the patient. Keywords-Head neck malignancy, clinically negative neck, US guided FNAC 1. Giuffrida D, Santonocito MG, Iurato MP, Freni V, Ippolito A, Squatrito S.Echography at "high resolution" in the diagnosis of cervical lymphadenopathies in follow-up of thyroid carcinoma.Minerva endocrinologica 1997;22(3):61-6. 2. Toriyabe Y, Nishimura T, et al. Differentiation between benign and metastatic cervical lymph nodes with US; Clinical Radiology 1997;52:927-32. 3. Righi PD, Kopecky KK, Caldemeyer KS, Ball VA, Weisberger EC, Radpour S. Comparison of ultrasound-fine needle aspiration and computed tomography in patients undergoing elective neck dissection. Head Neck. 1997;19(7):604-10. 4. Doldi SB, Lattudadaet al. Ultrasonic evaluation of cervical lymph nodes in preoperative staging of esophageal neoplasms. Abdom Imaging. 1998;23:275-7. 5. Leemans CR, Tiwari R, Nauta JJP et al. Regional lymph node involvement and its significance in the development of distant metastasis in head and neck carcinoma. Cancer 1993;71:452-6. 6. Hajeck PC, Solomonowitz E,Turk et al. Lymph node of neck: Evaluation with US.Radiology 1986;158:739-42. 7. Chang DB, Yuan A, Yu CJ, et al. Differentiation of benign andmalignant lymph nodes with color Doppler sonography. Am J Roentgenol 1994; 162:965-8. 8. Curtin, H. Ishwararn, H. Mancuso, et al.Comparison of CT and MRI imaging in staging of neck metastases Radiology 1998;207:123-30. 9. Stevens MH, Harnsberger HR, Mancuso AA, et al., Computed tomography of cervical lymph nodes: staging and management of head and neck cancer. Arch Otolaryngol 1985;111:735-9. 10. Van den Brekel MWM. Ultrasound guided fine needle aspiration cytology of neck nodes in patients with N0 disease. Radiology 1996;201:580-1.Abstract
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