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The role of ultrasound and ultrasound guided Fine needle aspiration cytology in detection and management of neck node metastases in clinically N0 patients with carcinoma of upper aero-digestive tract in remote part of underdeveloped country.

Date

24 Nov 2018

Session

Poster display - Cocktail

Presenters

Manju Gubhaju

Citation

Annals of Oncology (2018) 29 (suppl_9): ix94-ix104. 10.1093/annonc/mdy438

Authors

M. Gubhaju1, A.M. Bajracharya2

Author affiliations

  • 1 Clinical Research & Dental Department, Lumbini Medical College and Teaching Hospital, 44800 - Tansen/NP
  • 2 Radiodiagnosis, Lumbini Medical College and Teaching Hospital, 433000 - Tansen/NP
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Background

Presence of clinically occult cervical lymph metastases in patients with squamous cell carcinoma (SCCA) of upper aerodigestive tract and clinically negative (cN0) necks alters the management and prognosis. Single ipsilateral or contralateral metastatic node decreases survival by 50% and if there are bilateral nodes, it further reduces by 50%. The management of clinically positive neck is defined but in clinically negative cases it is controversial. Ultrasound of the neck is a useful but not standard part of pre-treatment work up in these patients.

Methods

Two hundred seventy newly diagnosed patients with SCCA of upper aero-digestive tract and cN0 necks were evaluated with pre-treatment ultrasound with power Doppler. Features studied were size, shape, number, echogenicity, presence/absence of echogenic hilum, vascular pattern, granular parenchymal echoes, internal deposits or necrosis. In patients who underwent neck dissection, the imaging findings were correlated with histopathology of lymph nodes. Abnormal lymph nodes detected on imaging were subjected to ultrasound guided FNAC, if neck dissection was not planned.

Results

Abnormal lymph nodes suspicious for metastases were detected in 103 (38.2%) patients on ultrasound. Fourty two ultrasound positive patients had non enlarged lymph nodes but other features suspicious for metastases. Pathological lymph node status was available in 126 patients and 72 of them had nodal metastases. Sensitivity, specificity and negative predictive values were 97%, 88% and 95% for ultrasound.

Conclusions

Ultrasound combined with fine needle aspiration cytology is very effective in detection of lymph node metastases in cN0 patients in skilled and experienced hands. It may be a great help in reducing risk of occult metastases to less than 20%. It may be useful in identifying patients suitable for conservative neck management. High spatial resolution, ease of multiplanar scanning, power Doppler and the ability to perform guided fine-needle aspiration for cytology give ultrasound (US) an advantage over other imaging techniques.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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