Differentiation between benign and metastatic cervical lymph nodes using ultrasound

Abstract

Purpose: The oral cavity is the most common site for squamous cell carcinoma, which has a distinct predilection for lymphatic spread before distant systemic metastasis. The cervical lymph node status is a very important consideration in the assessment of squamous cell carcinoma. Ultrasound is a noninvasive and inexpensive technique that can be used to differentiate between the benign and metastatic nodes. So the aim of this study was to evaluate reliability of ultrasound for such differentiation and to correlate them with histopathological finding. Materials and Methods: A total of 200 lymph nodes from 38 patients histopathologically proven for oral squamous cell carcinoma who underwent surgical neck dissection were considered. The patients underwent ultrasound examination of cervical lymph nodes prior to surgical neck dissection. The lymph nodes were differentiated into benign and metastatic based on the assessment of size, shape, shortest diameter/longest diameter (S/L ratio), margin, and internal architecture, and also the internal echo structure of the lymph nodes and histopathological findings were analyzed. Results: On correlation of ultrasonographic diagnosis with histopathological evaluation for metastatic lymph nodes, the overall accuracy of ultrasonographic analyses was 77.83%, and the sonographic criterion of irregular margin showed the highest predictability followed by the size. The correlation of internal echo structure with histopathological findings was highly variable. Conclusion: The ultrasound parameters such as size, shape, margin, S/L ratio, and internal echo structure might assist in differentiation between benign and metastatic lymph nodes. Combining these findings should raise the accuracy, as each sonographic parameter has some limitation as a sole criterion.

Evaluation of lymph node findings in patients with and without odontogenic infection: A clinical and ultrasonographic study

“…Previous studies have reported that the normal and reactive lymph nodes are oval, while the malignant and tuberculous lymph nodes are round ( 1 ). A different study found that the cervical lymph nodes are oval in all oral squamous cell carcinoma cases ( 5 ). In the present study, the shape of the submandibular and submental lymph nodes was mostly oval in both healthy and odontogenic infected individuals.…”

“…The ratio of the normal cervical lymph nodes is under 0.5, the ratio of a tuberculous lymph nodes is greater than 0.5, and the ratio of the lymph nodes with odontogenic infection is 0.47 ( 1 , 14 ). A rate 0.67 and above confirms a metastatic lymph node with a probability of 70.44% ( 5 ). In the present study, the mean ratio of the right and left submandibular lymph nodes with odontogenic infection were 0.55 and 0.60, respectively.…”

The Applications and Potential Developments of Ultrasound in Oral Cancer Management

“…Size, shape, echogenicity, echogenic hilum, internal echo, necrosis, margin, vascular pattern, elastography, and grouping or matting are reported to be US features associated with malignant nodal disease. 16 – 18 , 41 – 46 The accuracy of differentiation between benign and malignant LN varies according to nodal size and the optimal cutoff differs at different neck levels. 42 , 43 , 47 Shape is usually described in terms of the ratio between the short-axis and long-axis diameters (S/L ratio).…”

Validation of the Ultrasound Neck Node Reporting and Data System (UNN-RADS) for predicting lymph node metastases in thyroid cancer

“…It is important to note that while some US features are promising in identifying LN metastases, a single US feature cannot predict a malignant LN 1,4,5,[12][13][14][15][16][17] .…”