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\s=b\Nodal disease is a diagnostic problem in head and neck oncology. Current methods for investigation of the neck are not satisfactory as far as differentiation between necks with positive nodes and those with negative nodes is concerned. In the present study, the results of palpation and ultrasound examination were compared with histopathologic examination results of 120 neck dissection specimens. Furthermore, the value of ultrasound examination, combined with cytologic examination, of neck nodes was evaluated. Ultrasound examination was characterized by high sensitivity, ie, 96.8%; specificity was 32.0%. When the results of ultrasound-guided fine-needle aspiration biopsy were added to the ultrasound findings, specificity was as high as 92.9%. From these results, it was concluded that ultrasound examination with fine-needle aspiration biopsy is an accurate method for assessment of the neck in head and neck oncology. (Arch Otolaryngol Head Neck Surg 1989;115:689-690) Treatment and prognosis of pa¬ tients with head and neck malig¬ nant neoplasms are mainly deter¬ mined by nodal disease. Differentia¬ tion between necks with positive nodes and those with negative nodes, however, is still a diagnostic problem in head and neck oncology. Current methods for investigation of the neck are not satisfactory, as both palpation and computed tomography (CT) are characterized by high false-negative and false-positive rates.Reviewing relevant literature, it can be stated that palpation has a false-positive rate between 15% and 65% (most authors mention 25%) and a false-negative rate between 10% and 15% .M In a recent article by Feinmesser et al,5 the false-positive rate of CT was 18.4%, and the false-negative rate was 34%. In this study, no signif¬ icant differences in the false-positive and false-negative rates were demon¬ strated for palpation and CT.Low specificity and other draw¬ backs of CT (the need for using intra¬ venous contrast, radiation exposure, and high costs) have led us to test ultrasound examination as an alter¬ native imaging modality for investi¬ gation of the neck. Results of a pilot study were recently published.6 The present study was undertaken to com¬ pare palpation, ultrasound, and histo¬ pathologic findings. Furthermore, the value of fine-needle aspiration biopsy for cytologie study of neck nodes, in combination with ultrasound exami¬ nation, is evaluated. PATIENTS AND METHODSBetween December 1984 and April 1988, 100 patients with head and neck cancer were, before neck dissection, examined by palpation of the neck and ultrasound. With few exceptions, the malignant neoplasms were squamous cell carcinomas. Sixty-two necks were treated by radiotherapy before they entered the study. All patients were examined by one of the members of the oncologie staff (P.K.). Size and localization of palpable nodes were documented.Subsequently, patients were referred to the radiology department. Small-parts transducers of 5 or 7.5 MHz (Ana, Calif) were used for the ultrasound examination. The radiologist (R.J.R.) p...

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Deep neck abscesses may still result in significant morbidity and mortality. Surgical therapy carries the risk of damage to cranial nerves and arteries. Excellent results of ultrasound-guided percutaneous catheter drainage of abdominal abscesses led us to apply this technique to the management of deep neck abscesses. Five patients were treated with ultrasound-guided catheter drainage and antibiotics. All patients were cured without complications or recurrences. We consider this cheap and highly effective treatment as a valuable alternative to conventional therapy.

In a study of the value of ultrasound in staging patients with head and neck malignancies, we performed ultrasound of the neck. The results of this investigation were compared with palpation. A fine needle aspiration biopsy and/or histologic examination was carried out on lymph nodes which were found. One hundred and six patients were included in this study. In 44 of the patients no lymph nodes could be detected, either on palpation or by ultrasound examination. In the other 62 patients all palpable lymph nodes were also demonstrated by ultrasound. However, in 20 patients with negative palpatory findings, ultrasound revealed lymph nodes: 11 metastases and 9 benign nodes. In 40 patients an ultrasound guided fine needle aspiration biopsy (UGFNAB) was performed. In 85% of these patients a cytological diagnosis could be made. From these results we conclude that ultrasound and UGFNAB are of considerable value in staging head and neck malignancies.