Haruhiko Suzuki

Differential diagnosis of cervical lymph nodes in head and neck cancer by ultrasonography

OBJECTIVE Determination of whether an enlarged cervical lymph node is metastatic or not is clinically important in head and neck oncology. Differential diagnosis of the lymph node, however, is still a diagnostic problem. The purpose of this study is to clarify the ultrasonographic findings of the metastatic lymph nodes of head and neck squamous cell carcinoma and to establish the criteria. METHODS We investigated 36 metastatic lymph nodes in head and neck squamous cell carcinoma and 24 non-metastatic nodes in benign disease with a 10-MHz transducer. We examined the size, shape, and internal echo (echo level, punctate bright echogenic spots, hilus echogenic line, cystic pattern) of these nodes. Based on this investigation, we evaluated 70 lymph nodes from 25 other patients by ultrasonography. RESULTS The short axis diameter and shape of metastatic nodes were larger and rounder than those of non-metastatic ones. Of the metastatic nodes, 69% showed hypoechoic and 31% isoechoic levels, and 78% exhibited punctate bright echogenic spots. Of the non-metastatic nodes, 92% showed hypoechoic and 8% isoechoic levels, and none of them showed the spots. The hilus echogenic line was not present in any metastatic node, but it was seen in 58% of non-metastatic ones. Of the metastatic nodes, 19% exhibited a cystic pattern; none of the non-metastatic nodes showed the pattern. According to our criteria based on these results, the accuracy rate was 98.6% (69/70). The sensitivity and specificity were 97.2% (35/36) and 100% (34/34), respectively. The false positive rate and the false negative rate were 0% (0/70) and 1.4% (1/70), respectively. CONCLUSION Internal echo findings and shape of lymph nodes can be an important diagnostic tool, and our ultrasonographical criteria of the lymph nodes are very useful for the differential diagnosis of the cervical lymph nodes.

Hemodynamic Changes in the Head and Neck after Ligation of the Unilateral Carotid Arteries: A Study Using Color Doppler Imaging

For evaluation of the hemodynamics of the collateral circulation to the ligated external carotid artery (ECA) region, we measured the blood flow direction and volume in branches of the ECA in patients with unilateral carotid artery ligation before and during digital suppression of the common carotid artery (CCA) on the ligated and nonligated sides with color Doppler imaging and angiography. The main collateral pathway to the ligated ECA region was the ipsilateral occipital artery through Richters anastomosis from the vertebral artery in the case of unilateral ECA ligation, and was the contralateral carotid artery in the case of unilateral CCA, ECA, and internal carotid artery resection. The superior and inferior labial arteries were important as the collateral pathway from the contralateral ECA.

Differential diagnosis of pulsatile neck masses by Doppler color flow imaging.

A pulsatile neck mass (PNM) requires careful judgment in its evaluation, and it is difficult and inaccurate to diagnose a PNM only by physical examination, even though a thrill or bruit is present. Doppler color flow imaging (DCI) was performed as an initial evaluation in nine patients with PNMs. Intravenous digital subtraction angiography, intra-arterial angiography, X-ray computed tomography, and magnetic resonance imaging were performed in selected cases. The DCI revealed seven vascular masses (three tortuosities of the common carotid artery, two tortuosities of the brachiocephalic artery, one pseudoaneurysm, and one traumatic arteriovenous fistula) and two nonvascular masses (one neurofibroma and one metastatic lymph node). The clinical diagnoses of all the vascular masses were defined by DCI. In nonvascular masses, fine-needle aspiration biopsy could be performed relatively safely and accurately by monitoring the feeding artery or the common carotid artery by DCI. This method was quite useful for the initial evaluation in the differential diagnosis of PNMs.

Basal cell adenocarcinomas of the submandibular and parotid glands recognized simultaneously report of a case.

Basal cell adenocarcinomas (BCAC) of the major salivary glands are rare tumors. We experienced a case of BCACs that were recognized simultaneously in the submandibular and parotid glands. The case like this has not been reported previously. We present the case and discuss clinicopathologically the relation between the both tumors. Macroscopically, there was no direct infiltration between the both tumors. Microscopically, neural and perineural invasion were not found in both tumors. Distant hematogenous metastasis to other organs was not found. The fact that the parotid tumor had strong necrotic change and had no nodal structure suggests that the metastatic node had been rapidly enlarged beyond the size of the normal lymph node. It is reasonable to suppose that the submandibular tumor is a primary lesion and the parotid tumor is a metastatic lymph node.

A proposal of TNM classification system for cancer of the salivary gland--comprehensive retrospective study.

Until recently, there has not been a sufficient number of cases of salivary gland cancer to permit the development of a clinically useful TNM classification system. A comprehensive retrospective study of 354 patients with cancer of the parotid gland from 46 institutions in Japan was carried out at the request of the Japanese Committee on TNM Classification (JJC), and we propose JJC T-categories for parotid gland cancer. The characteristic of this proposal involves T-categories determined according to tumor size. Fixed tumors or tumors with facial nerve involvement were classified as T4 regardless of tumor size. In 1983, the AJC proposal for a TNM classification system of salivary gland cancers was tentatively approved at a AJC/UICC joint meeting. In comparison with the AJC classification, our proposal seems to be better in terms of simplicity and the balanced distribution in T-categories of parotid gland cancers.