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Year : 2013  |  Volume : 3  |  Issue : 1  |  Page : 35-39

Enlarged lymph nodes in head and neck cancer: Analysis with triplex ultrasonography

1 Department of Oral and Maxillofacial Surgery, Mauras College of Dentistry and Hospital and Oral Research Institute, Davangere, Karnataka, India
2 Cranio Maxillofacial and Reconstructive Surgery, College of Dental Sciences, Davangere, Karnataka, India

Correspondence Address:
Vivek Sathyanarayan
Department of Oral and Maxillofacial Surgery, The Oxford Dental College and Hospital, 10th Mile Stone, Bommanahalli, Hosur Road, Bangalore, Karnataka - 560 068
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DOI: 10.4103/2231-0746.110077

PMID: 23662257

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Background: Presence of cervical metastasis is one of the factors influencing the outcome of patients with carcinoma of the head and neck, its early detection is potentially very important. Triplex ultrasonography technology have definitive role in detecting clinically undetectable involvement of lymph nodes (LNs). The purpose of this study was to evaluate, whether triplex ultrasonography characterization of cervical LNs could, with an acceptable degree of certainty, differentiate malignant from benign/reactive LNs, in order to prevent invasive diagnostic procedures. Materials and Methods: A total of 50 patients with oral cancer, were subjected to ultrasonographic investigation of the neck for grayscale, color flow imaging, and pulsed Doppler. All the parameters were compared with histopathologic examination. Correlation was then made between ultrasound and Doppler investigation and histopathology results to evaluate the sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV) of color Doppler ultrasonography in detecting metastatic neck nodes. Results: Study results showed that malignant LNs, especially metastatic nodes, are accompanied with significantly high resistive index (RI) and pulsatility index (PI) values, rounded shape, size, loss of central hilar echogenicity and peripheral vascularity. Among these sonographic findings, nodal shape (longitudinal nodal diameter to transverse diameter ratio or L/T ratio), RI and PI values were more accurate for differentiating benign from malignant LNs. Conclusion: In this study, triplex sonographic findings had relatively high accuracy in differentiating benign from malignant cervical LNs. Ultrasound hence can be recommended for initial non-invasive evaluation of the neck in patients with oral cancers with or without palpable cervical lymph nodes.

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