Contributions Of B-ultrasonography In Diagnosis Of Cervical Lymph Node Metastasis Of Malignant Tumors Of Ear, Nose And Throat

It is important to distinguish cervical lymph node metastasis of malignant tumors of ear, nose and throat, not only for the tumor staging but also for therapy strategy and prognostic estimation. More recently, B-ultrasonography has been frequently used for the purpose of diagnosis in addition to typical cervical palpation. In our present study, the available clinical data of 63 patients with malignant tumors of ear, nose and throat were reviewed. Their documents of cervical palpation, B-ultrasonography and pathologic examination were retrospectively analyzed, and thus we could discuss the contributions of B-ultrasonography in diagnosing cervical lymph node metastasis of malignant tumors of ear, nose and throat.Materials and MethodsThe crude clinical data of 310 patients with malignant tumors of ear, nose and throat were reviewed. They were hospitalized in the department of Otorhinolaryngology in the second affiliated hospital of medical school of Zhejiang University between January 1997 and March 2003. Among them 150 cases were suspected of cervical lymph node metastasis and underwent operations of cervicallymph node biopsy and /or regional, functional or radical neck dissection. From these 150 cases, 63 cases, with involvement of 69 sides of neck, were selected for retrospectively analyzed since their clinical data of preoperative cervical palpation and B-ultrasonography as well as postoperative pathologic examination could be completely obtained. We contrasted the findings of cervical palpation and B-ultrasonography with the pathologic diagnosis. The sensitivity, specificity and accuracy of cervical palpation and B-ultrasonography were calculated respectively. The difference of sensitivity, specificity and accuracy between cervical palpation and B-ultrasonography were statistically analyzed by x2 test.ResultsWe found the sensitivity, specificity and accuracy of cervical palpation were 62.50%, 70.27% and 66.67% respectively while the sensitivity, specificity and accuracy of B-ultrasonography were 96.89%, 35.14% and 63.76% respectively. The difference of sensitivity between cervical palpation and B-ultrasonography wasstatistically significant (x2 =11.68, P<0.05), and the same was the difference of specificity between cervical palpation and B-ultrasonography (x2=9.16, P<0.05).Discussion and ConclusionsIn respect of diagnosing cervical lymph node metastasis of malignant tumors of ear, nose and throat, our preliminary findings revealed that the sensitivity of B-ultrasonography was higher than that of cervical palpation while the specificity of B-ultrasonography was lower than that of cervical palpation. This indicates that B-ultrasonography can make up some deficiencies of cervical palpation such as low sensitivity. A high index of suspicion should be kept and sufficient attention should be paid in case a cervical lymph node is nonpalpable, however, the measurements of B-ultrasonography meet one of following criteria:â‘ The longest diameter is more than 10 mm, â‘¡The ratio of long- to short- axis diameter (L/S) is less than 2, or â‘¢The nodal hilus is destroyed or internal echo structure is heterogeneous pattern.