W. King

Metastatic cervical nodes in papillary carcinoma of the thyroid : ultrasound and histological correlation

The ultrasound appearances and histological correlation of metastatic cervical lymph nodes in 20 patients with papillary carcinoma of the thyroid are presented. The majority of the malignant nodes were homogeneous (81.2%), hyperechoic (87.5%) compared to adjacent sternomastoid muscle and 68.7% showed peripheral punctate calcification on US and histology. Histology revealed that the peripheral echogenic foci seen within the nodes on US correlated with psammoma bodies which are characteristic for papillary carcinomas, highlighting the importance of recognizing peripheral punctate calcification in the cervical nodes as a useful sign for the diagnosis of metastatic papillary carcinoma of the thyroid.

Role of ultrasound in the management of thyroid nodules

One hundred twenty patients undergoing thyroid surgery for thyroid nodules or goiter were examined by preoperative ultrasound and fine needle aspiration (FNA) cytology. In the determination of whether a lesion was malignant, FNA had sensitivity, specificity, and positive predictive values of 86%, 85%, and 58%, respectively. Ultrasound had sensitivity, specificity, and positive predictive values of 74%, 83%, and 51%, respectively. The different types of thyroid pathology showed different ultrasonic features in most cases, although no single feature was pathognomonic. Malignant lesions tended to be solid and hypoechoic without a halo, but there was a cystic element in 26% of the lesions and calcification in 37%. Ultrasound was superior to FNA in diagnosing nodular goiter with sensitivity, specificity, and positive predictive values of 70%, 93%, and 92%, respectively, compared with 55%, 86%, and 83%, respectively. The two modalities are complementary.

High resolution sonographic detection of axillary lymph node metastases in breast cancer.

Axillary lymph node status is crucial in the evaluation of prognosis and in treatment planning of breast cancer. High‐resolution real‐time sonographic scans of the breast and both axillae were performed on 114 patients with breast carcinoma, all of whom had axillary lymph node dissection and histologic assessment. The sensitivity of high‐resolution ultrasonography in the detection of axillary nodal metastases was 84.1%, with a specificity of 97.1%, accuracy of 92.1%, positive predictive value of 94.9%, and negative predictive value 90.7%. Ultrasonography of the axilla provides good information on anatomy and pathology and may have a potential role in the prognostic work‐up of patients who are not surgical candidates.

Clinical significance of the comet‐tail artifact in thyroid ultrasound

The comet‐tail artifact is commonly encountered in a variety of clinical conditions; however, its presence and significance in a thyroid nodule has not been documented before. We document its presence in 100 patients who underwent ultrasound examinations of the neck and thyroid. None of the thyroid nodules showed any evidence of malignancy on repeated fine‐needle aspiration cytology (FNAC). In 85% of patients with the artifact, abundant colloid was seen on FNAC, suggesting that the artifact may be related to the presence of colloid. Four different patterns of distribution of the artifact within the nodule were noted and these helped to determine the size of the needle to be used for a successful aspiration.

Nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma : A twelve-year experience

The incidence of recurrent nasopharyngeal carcinoma (NPC) after primary radiotherapy is considerable. The result of re‐irradiation to the recurrent tumor is not satisfactory.

Squamous carcinoma of the gums

We reviewed a 20-year experience with squamous carcinoma of the gums in 347 patients who received definitive therapy. More than three-quarters of the lesions involved the lower gum and all but 37 patients were previously untreated. The proportion of patients with localized tumors (N0) remained the same (64 percent). Surgery continued to be the treatment of choice in 97 percent of patients, but proportionately more patients had a more conservative procedure which preserved lower jaw continuity. The 5-year determinate survival rate was little changed (54 percent). Advanced clinical stage (stages III and IV), prior dental extraction, bone invasion, and involvement of surgical margins were predictive of a lower survival rate on univariate analysis. Clinical stage was the only significant predictor of survival on multivariate analysis. The impact of adjunctive radiotherapy could not be assessed.

Sonographic, magnetic resonance imaging, and mammographic assessments of preoperative size of breast cancer.

High resolution sonographic (39 cases), magnetic resonance imaging (32 cases), and mammographic (35 cases) measurements of preoperative size of breast cancer were correlated with the pathologic size in 39 patients with breast carcinoma to determine the most accurate imaging technique for breast cancer size. There were nine T1, 21 T2, four T3, and four T4 tumors. Sonographic and magnetic resonance imaging measurements of tumor size demonstrated correlation coefficients of 0.92 and 0.93, respectively, both of which were superior to that of mammography (0.84). Sonographic tumor size evaluation thus is shown to be equivalent to magnetic resonance imaging in this study. Three of nine (33%), four of seven (57%), and four of eight (50%) T1 tumors would have been overstaged by ultrasonography, magnetic resonance imaging, and mammography, respectively. Three of 21 (14.3%), one of 16 (6.3%), and two of 18 (11.1%) T2 tumors would have been understaged by ultrasonography, magnetic resonance imaging, and mammography, respectively. We therefore found ultrasonography to be of value in the diagnosis and staging of breast cancer.

Cervical lymphadenopathy: Sonographic differentiation between tuberculous nodes and nodal metastases from non–head and neck carcinomas

Clinical examination alone cannot differentiate between cervical tuberculous lymphadenitis and cervical nodal metastases from non–head and neck (NHN) carcinomas because the distributions of involved lymph nodes are similar. We evaluated the sonographic features of cervical lymph nodes that could be used to differentiate between the 2 categories of nodes.

A practical approach to ultrasound of cervical lymph nodes

Although the role of high resolution ultrasound (US) in evaluating cervical nodes is well established, it is often combined with fine needle aspiration cytology (FNAC). As a result, US appearances that help in distinguishing the various causes of cervical adenopathy are often overlooked and not emphasized. The aim of this study is to re-emphasize to the sonologist the US clues that may help in differentiating the aetiology of abnormal cervical nodes. We, therefore, present the spectrum of US appearances of lymph nodes. One hundred and forty patients (702 abnormal nodes) with known pathology were compared with 100 normal subjects (1211 nodes). After identifying an abnormal nodes, US features that further help in distinguishing between the various pathologies are the distribution of lymphadenopathy, echogenicity, calcification, distal enhancement, intranodal cystic necrosis, matting and soft tissue oedema.

The use of sonography in differentiating cervical lymphomatous lymph nodes from cervical metastatic lymph nodes

Lymphoma and metastases are common causes of cervical lymphadenopathy. Clinical examination alone is unable to differentiate the two. Ultrasound (US) with its high sensitivity and specificity when combined with a find needle aspiration cytology (FNAC) is therefore the ideal initial investigation. We present the spectrum of findings in 19 patients with non Hodgkins lymphoma (NHL), 15 patients with pharyngeal, laryngeal and oesophageal (PLO) carcinomas, 22 patients with oral cavity tumours and 12 patients with infraclavicular carcinomas. The US features found consistently useful in differentiating NHL from other metastases were the distribution of the nodes, distal enhancement and lack of intranodal necrosis. Other US features of abnormal nodes helped identify abnormality but did not help in differentiation.