Abstract
Simple SummaryUltrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for N-staging in head and neck squamous cell carcinoma (HNSCC). The specificity of USgFNAC is always in the order of 100% as false positive cytology is rare. The difference in sensitivity is mainly attributable to selection of the lymph nodes to aspirate and aspiration technique. The aim of this study was to improve the selection criteria of lymph nodes to aspirate. Ultrasound features of nodes such as a short axis diameter, S/L ratio, loss of a fatty hilum sign, resistive index, and peripheral or mixed hilar and peripheral vascularization, obtained by Micro-flow imaging (MFI), which is a new technique to obtain micro-vascularization, were evaluated. To calculate the sensitivity and PPV of each feature, data of sonographic findings and cytological results of all aspirated nodes were statistically analyzed. We found that next to size, peripheral vascularisation obtained by MFI and absent hilum sign have a high predictive value for malignancy and should be added as selection criteria for fine needle aspiration in lymph nodes.Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in head and neck squamous cell cancer (HNSCC). Peripheral vascularity is a described feature for node metastasis. Micro-flow imaging (MFI) is a new sensitive technique to evaluate micro-vascularization. Our goal is to assess the additional value of MFI to detect malignancy in lymph nodes. A total of 102 patients with HNSCC were included prospectively. USgFNAC was performed with the Philips eL18–4 transducer. Cytological results served as a reference standard to evaluate the prediction of cytological malignancy depending on ultrasound features such as resistive index (RI), absence of fatty hilum sign, and peripheral vascularization. Results were obtained for all US examinations and for the subgroup of clinically node-negative neck (cN0). USgFNAC was performed in 211 nodes. Peripheral vascularization had a positive predictive value (PPV) of 83% (cN0: 50%) and the absence of a fatty hilum had a PPV of 82% (cN0 50%) The combination of peripheral vascularization and absent fatty hilum had a PPV of 94% (cN0: 72%). RI (threshold: 0.705) had a PPV of 61% (cN0: RI-threshold 0.615, PPV 20%), whereas the PPV of short axis diameter (threshold of 6.5mm) was 59% for all patients and 19% in cN0 necks (threshold of 4 mm). Peripheral vascularization assessed by MFI and absent hilum has a high predictive value for cytological malignancy in neck metastases. Next to size, both features should be used as additional selection criteria for USgFNAC.
Highlights
One of the most important predictors for the survival of patients with head and neck squamous cell carcinoma (HNSCC) is the nodal status [1]
The aim of this study was to evaluate the additional value of peripheral vascularization in lymph nodes as assessed by Micro-flow imaging (MFI) as a criterion to diagnose metastasis or select lymph nodes to be punctured by ultrasound-guided fine needle aspiration-cytology (USgFNAC) next to other criteria such as nodal size, fatty hilum sign, and resistive index (RI) obtained in the same nodes
USgFNAC was performed in 211 nodes from 102 patients. (Table 1) The mean number of USgFNAC punctures per patient was 2.07
Summary
One of the most important predictors for the survival of patients with head and neck squamous cell carcinoma (HNSCC) is the nodal status [1]. Metastatic disease that spreads from the primary lymph node to distant organs causes 90% of all HNSCC deaths. Neck palpation for lymph nodes in patients with HNSSC has a sensitivity and specificity to detect metastatic disease of 60–70% [4]. Used imaging tools to detect these occult metastases are ultrasound (US), magnetic resonance imaging (MRI), contrast enhanced computer tomography (CT), FDG PET-CT, and ultrasound-guided fine needle aspiration-cytology (USgFNAC). MRI and CT are frequently used to stage the primary tumor and neck, but use morphological criteria for metastases with a relatively low accuracy (74–78%) [5]. For cN0 neck, with only small metastases, the sensitivity is in the range of 40–60% and not very high [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
