Ultrasonography—imaging method for oropharyngeal SCC lymphnode metastases mapping

Background : Lymphatic drainage in the head and neck region is known to be particularly complex. This study explores the value of ultrasonography for oropharyngeal carcinoma and lymph node metastases in the head and neck region. New technology being incorporated into the surgical oncology and general surgery practice has the potential of changing the way many solid tumours are treated. The new procedures promise to be more conservative and less morbid for the patient, but at the same time result in better staging for the patient. The development of protocols for lymphatic mapping has started the examination of the applicability of answers to key questions concerning the technology, including the clinical relevance of upstaging that occurs with a more detailed examination of the lymph node. Methods : 51 consecutive patients with clinically localised oropharyngeal carcinoma and the lymph node metastases in the head and neck region were included. Ultrasonography was performed with Hitachi EUB420 7.5 MHz transducer after CT or NMR imaging. We compare the value of preoperative ultrasonography sensitivity for oropharyngeal tumour and lymph node metastases in head and neck. The value of ultrasonography in the follow-up is discussed. The aim of the present study was to define the influence of different types imaging of the lymphatic mapping and volumetry of lymph nodes on the head and neck and their sensitivity for TNM classification of oropharyngeal carcinoma. We divided the lymph nodes according to classification into five or six areas on the neck, respectively. Results : The lymph node metastases were observed in 62% of patients. The false positive lymph nodes were observed for N1. Ultrasonography sensitivity of the procedure was 94% in general. The specificity is discussed. The specificity of ultrasonography depend from N staging, for N2 and N3 state is over 90%, in N0 and N1 from 50% to 70% only. Conclusions : The ultrasonography (B scan) in the head and neck region is a technically demanding procedure. Our results had shown that the ultrasonography detected the lymph nodes similar to other imaging methods. We recommend the ultrasonography in standard management of oropharyngeal SCC carcinoma. The other imaging methods (CT, NMR, PET-scan) we recommended facultative only. We use the ultrasonography as cost effective, precious, no-radiation imaging method. The ultrasonography guided biopsy and/or surgery is discussed. The lymph node mapping uses the ultrasonography we added to management of metastatic disease of oropharyngeal carcinoma. Lymph node volumetry is a simple and practical method. It can be used easily in clinical routine.