Source: Journal of Ultrasound in Medicine
Author: Staff

Probability of Metastasis

Heung Cheol Kim, MD, Dae Young Yoon, MD, Suk Ki Chang, MD, Heon Han, MD, So Jung Oh, MD,Jin Hwan Kim, MD, Young-Soo Rho, MD, Hwoe Young Ahn, MD, Keon Ha Kim, MD andYoon Cheol Shin, MD

Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea (H.C.K., H.H.); Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea (H.C.K.); Departments of Radiology (D.Y.Y., S.K.C.) and Otorhinolaryngology and Head and Neck Surgery (S.J.O., J.H.K., Y.-S.R., H.Y.A.), Ilsong Memorial Institute of Head and Neck Cancer, and Department of Thoracic Surgery (Y.C.S.), Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea; and Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea (K.H.K.).

Address correspondence to Dae Young Yoon, MD, Department of Radiology, Ilsong Memorial Institute of Head and Neck Cancer, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong, Kangdong-gu, Seoul 134-701, Korea. E-mail: [email protected]

Objective. The purpose of this study was to assess the probability of metastasis of small atypical cervical lymph nodes detected on sonography in patients with squamous cell carcinoma (SCC) of the head and neck. Methods. We reviewed, retrospectively and blindly, sonographic findings of 148 patients (118 men and30 women; mean age, 58.2 years) who underwent curative neck dissection. Each lymph node was classified by using a 4-point scale: 1, definitely benign; 2, indeterminate (small [short-axis diameter <10 mm for levels I and II and <7 mm for levels III–VI] atypical node); 3, definitely metastatic; and 4, large (>3-cm) metastatic. Lymph nodes were considered atypical if they met at least 1 of the following criteria: a long- to short-axis diameter ratio of less than 2.0, absence of a normal echogenic hilum, and heterogeneous echogenicity of the cortex. These results were verified, on a level-by-level basis, with histopathologic findings.Results. Small atypical nodes were found on sonography in 63 cervical levels of 48 patients, of which 18 (28.6%) were proved to have metastatic nodes. Theprobability of metastasis was significantly higher with than without a large (>3-cm) ipsilateral metastatic node (0.50 versus 0.20; P = .038) and marginally higher with than without an ipsilateral metastatic node (0.41 versus 0.16; P = .061) but not significantly associated with the T stage of the primary tumor (P = .238) or the presence of an ipsilateral tumor (P = .904). Conclusions. Metastasis was encountered in about 30% of small atypical cervical nodes on sonography in patients with SCC of the head and neck. Our results indicate that small atypical nodes must be interpreted with consideration of metastatic nodes in the ipsilateral neck.

Key Words: head and neck • lymph node • metastasis • sonography • squamous cell carcinoma

Abbreviations: L/S, long- to short-axis diameter • SCC, squamous cell carcinoma