Surgeon‐performed Transoral Ultrasound‐Guided Aspiration of Peritonsillar Abscess

Todsen, Tobias; Stage, Mads Georg; Hahn, Christoffer Holst

doi:10.1002/lary.29525

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…The training or qualifications of the sonographers were not specified in 13 studies. The remaining five studies all described differing levels of training or qualification: (a) ultrasound credentialed at their hospital, 26 (b) met the ACEP emergency ultrasound training guidelines, 20 (c) a 30‐min didactic and hands‐on session, 21 (d) certification by the German Society of Ultrasound in Medicine, 30 and (e) formal training with >300 prior head and neck ultrasound scans 32 …”

Section: Resultsmentioning

confidence: 99%

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Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta‐analysis

Kim

Burton

Hammad

et al. 2023

Academic Emergency Medicine

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Background Distinguishing peritonsillar abscess (PTA) from peritonsillar cellulitis using clinical assessment is challenging as many features overlap for both conditions, and physical examination is only about 75% sensitive and 50% specific for diagnosing PTA. The primary objective of this systematic review was to determine the test characteristics of ultrasound for diagnosing PTA when compared to a reference standard of computed tomography or acquisition of pus via needle aspiration or incision and drainage. Methods This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta‐analysis of Diagnostic Test Accuracy (PRISMA‐DTA) guidelines. We searched seven databases from 1960 to November 2022. Two independent reviewers completed study selection, data extraction, and QUADAS‐2 risk‐of‐bias assessment. We used a bivariate random‐effects model to calculate pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR–). We also conducted subgroup analyses on radiology ultrasound compared to point‐of‐care ultrasound (POCUS) and intraoral compared to transcervical scanning techniques. Results From 339 citations, we identified 18 studies for inclusion. Because one study only reported positive cases of PTA (thereby preventing the calculation of specificity), it was excluded from the analysis, so the analysis included a total of 17 studies with 812 patients, of whom 541 had PTA. Pooled bivariate sensitivity was 86% (95% confidence interval [CI] 78%–91%), specificity 76% (95% CI 67%–82%), LR+ 3.51 (95% CI 2.59–4.89), and LR– 0.19 (95% CI 0.12–0.30). On subgroup analysis, radiology‐performed ultrasound had a sensitivity and specificity of 89% and 71%, compared to POCUS, which had a sensitivity and specificity of 74% and 79%. Comparing the two different techniques, intraoral had a sensitivity and specificity of 91% and 75% while transcervical had a sensitivity and specificity of 80% and 81%. Conclusions Ultrasound demonstrates high sensitivity for ruling out PTA, but it only has moderate specificity for ruling in the diagnosis.

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Section: Resultsmentioning

confidence: 99%

“…formal training with >300 prior head and neck ultrasound scans. 32 Figure 2 summarizes the quality assessment using the QUADAS-2 tool. One study 23 was only published as a conference abstract and not as a full-text manuscript, so it could not be assessed using QUADAS-2.…”

Section: Re Sultsmentioning

confidence: 99%

Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta‐analysis

Kim

Burton

Hammad

et al. 2023

Academic Emergency Medicine

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“…With the development of small-footprint US transducers, the intraoral US technique has shown potential for oral tongue cancer detection and depth-of-invasion estimation [ 22 , 23 ]. For the oropharynx, a transoral US approach has shown improved visualization compared to transcervical US for the diagnosis of peritonsillar abscesses [ 24 , 25 ]. A small-sample feasibility study found that outpatient-performed transoral US had high sensitivity and specificity to differentiate oropharyngeal tumors from normal tissue, but the study was not performed blinded to histopathology for all included cases [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transoral and Transcervical Ultrasonography with MRI for the Diagnostic Work-Up of Oropharynx Tumors: A Protocol for a Multicenter Clinical Trial (SPOTUS)

Garset-Zamani,

Hvilsom,

Kjærgaard

et al. 2024

Diagnostics

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This study protocol for a prospective, multicenter, diagnostic, clinical trial describes the integration of transoral and transcervical ultrasonography (US) in the initial clinical work-up of patients referred to tertiary head and neck cancer centers with suspected oropharyngeal cancer. The study evaluates the blinded detection rate of oropharyngeal tumors and their US-estimated size and T-stage before histopathology and cross-sectional imaging are available. Magnetic resonance imaging (MRI) scans will be prospectively rated while blinded to T-site histopathology and US. The primary outcome measures of diagnostic accuracy, including sensitivity, specificity, positive and negative predictive values, and overall accuracy, will be reported for both US and MRI. A sub-analysis of prospectively rated 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) scans in patients with clinically suspected unknown primary tumors will also be compared to US and MRI. Secondary outcome measures, including a comparison of tumor size estimation between US, MRI, and CT, will also be reported. This prospective multicenter study will provide clinically impactful information regarding the use of transoral and transcervical US for the diagnostic work-up of oropharyngeal cancer.

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“…High-frequency, small-footprint US transducers have recently been developed, resulting in increased superficial soft tissue resolution. We have previously described the use of transoral US for detecting peritonsillar abscesses [17,18]; however, the potential of high-frequency transoral US to diagnose OPCs has not been investigated in any prospective trials. Furthermore, since surgeon-performed neck US is increasingly used worldwide [19][20][21], we believe transoral US may be added to the outpatient clinical work-up.…”

Section: Introductionmentioning

confidence: 99%

Transoral Ultrasound in the Outpatient Clinic for the Diagnostic Work-Up of Oropharyngeal Cancer: A Feasibility Study

Garset-Zamani,

Norling,

Hahn

et al. 2023

Cancers

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Magnetic resonance imaging (MRI) is the preferred imaging modality for oropharyngeal cancers (OPCs), but it has difficulties distinguishing between small OPCs and unilateral tonsil hypertrophy. We hypothesized that surgeon-performed transoral ultrasound (US) could be used to accurately detect T-stage OPCs. We performed a single-center prospective diagnostic accuracy study including patients with suspected or biopsy-verified OPCs during outpatient appointments. All patients were offered transoral US and MRI. If transoral US could not be tolerated by the patient, transcervical US was performed. The primary outcome was the diagnostic accuracy of detecting OPCs with US compared to MRI, using histopathology as the reference standard. The secondary outcome was comparing the primary tumor diameters between US and MRI blinded to each other. Out of the 26 patients included in the study, 21 (81%) had OPCs. Transoral US could be performed in 21/21 and 1/5 patients with suspected palatine and lingual tonsil OPCs, respectively. Overall, US diagnostic accuracy was 92%, compared to 81% with MRI (p = 0.37). US and MRI had a high correlation between tumor diameters in the anteroposterior diameter (R = 0.80, p < 0.001), corresponding to the depth axis on US. In conclusion, this small study showed the promise and feasibility of transoral US to improve the initial clinical evaluations of patients with suspected OPCs.

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Surgeon‐performed Transoral Ultrasound‐Guided Aspiration of Peritonsillar Abscess

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Cited by 6 publications

References 6 publications

Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta‐analysis

Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta‐analysis

Comparison of Transoral and Transcervical Ultrasonography with MRI for the Diagnostic Work-Up of Oropharynx Tumors: A Protocol for a Multicenter Clinical Trial (SPOTUS)

Transoral Ultrasound in the Outpatient Clinic for the Diagnostic Work-Up of Oropharyngeal Cancer: A Feasibility Study

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