Diagnostic imaging in head and neck disease: current applications of ultrasound

Sonographic appearance of branchial cysts

Branchial cysts are developmental anomalies arising from remnants of the foetal branchial apparatus. Two patients in whom the presence of a branchial cyst was confirmed at surgery had undergone pre-operative neck ultrasound examination. In each case the cysts showed a characteristic uniform low echogenicity. Recognition of this appearance allows prompt and appropriate further investigation and treatment.

Reduction of the number of neck treatments in patients with head and neck cancer

With modern diagnostic imaging techniques, the head and neck oncologist is faced with increasing information on the status of neck nodes of patients with head and neck cancer. It is often difficult to include this new diagnostic information in clinical management because strategies of neck treatment date from times when only clinical examination was available. Computed tomography, magnetic resonance imaging, and ultrasonography (US) may provide information on the status of neck nodes. In the University Hospital Leiden and the University Hospital Rotterdam, US of the neck, when combined with ultrasonographic fine-needle aspiration biopsy (US-UGF-NAB), has proved to be an accurate diagnostic test for nodal disease. The combined procedure is characterized by high sensitivity and specificity. Therefore, this technique is suited for detecting, demonstrating, and excluding nodal metastases. This article will discuss how to interpret the new diagnostic information supplied by US-UGFNAB. A different approach in the clinical management of the neck, based on techniques from the field of clinical decision analysis, will be presented. It is concluded that US-UGFNAB is a promising concept of methodic use of both cytologic examination and an imaging technique in the examination of patients with squamous cell carcinoma of the upper aerodigestive tract. Application of the test may produce an accurate classification of patients with a head and neck tumor and change indications for elective and therapeutic neck treatment.

Ultrasound B-scans in the follow-up of head and neck tumors

In recent years, diagnostic ultrasound has become established in head and neck surgery. Modern equipment allows high resolution imaging of neck tissue masses, cervical vessels, and lymph nodes. The major advantage of B-mode sonography is its ability to detect neoplasms in solid scarred neck tissue, commonly seen in patients with radical neck surgery. Postoperative or radiogenic edema, tumor recurrence, and lymph node involvement can be differentiated. Inflammatory and neoplastic lymph node diseases detected by echography must be differentiated by biopsy. Tumor recurrence was seen in 21 of 152 patients by echography. Twelve patients were diagnosed by clinical examination and 17 were diagnosed by computed tomography. Two false positive and one false negative sonographic diagnoses were made. B-mode sonography is an important instrument in the follow-up examination of head and neck tumors for early detection of tumor recurrence or tumor persistence.

A case of branchial (lympho-epithelial) cyst, illustrating the value of ultrasound in diagnosis of cervical swellings

Ultrasound has until recently found little application in oral and maxillofacial surgery despite wide use in other specialties. Ultrasound imaging uses the reflection of pulses of high frequency sound to display soft tissues and to differentiate between tissue types, particularly solid and cystic. A case of branchial (lymphoepithelial) cyst is presented to illustrate the use of ultrasound, and the aetiology and histogenesis of this controversial lesion is discussed. Ultrasound as a safe, painless, non-invasive technique is recommended as an additional investigation for neck swellings, particularly in view of the high incidence of malignancy claimed to occur in this region.

Ultrasound as a diagnostic aid in maxillofacial surgery. Report of a case

Ultrasonographic examination of masses in the neck can be a valuable diagnostic aid. It has the advantages of being noninvasive, rapid, easily repeated, and relatively inexpensive. Ultrasound is also a particularly convenient means of localizing lesions for percutaneous biopsy and for serially monitoring the response of a lesion to therapy. As experience increases and equipment improves, ultrasound will gain an even greater role as a diagnostic aid. A case is reported in which a mucus-retention phenomenon was evaluated, managed, and followed with the aid of B-scan ultrasonographic and real-time imaging.

Recent advances in ultrasound: high-resolution imaging of superficial structures

In the past few years, sophisticated ultrasound systems specifically designed for the evaluation of superficial organs and structures have been developed. These "high-resolution" scanners are particularly well suited to diagnostic imaging in the neck. This review summarizes current clinical applications of this evolving technology and highlights initial experience with a prototype scanner that is now commercially available. Particular attention is directed to high-resolution ultrasonography of the thyroid and parathyroid glands, the extracranial carotid arteries, and neoplastic and inflammatory masses of the neck.U

Management of thyroid nodules. I: History and physical examination, blood tests, X-ray tests, and ultrasonography

The approach to the management of the thyroid nodule remains controversial. Confusion exists because virtually any thyroidal disease can present as a clinically solitary nodule which means there is no uniformity regarding natural history, incidence, prevalence, epidemiology, and pathophysiology.. The variety of definitions of thyroid nodules and thyroid carcinoma and the different modes of study selection and individual bias add to the confusion. Diagnostic approaches have not yielded a completely reliable technique to differentiate benign from malignant thyroidal disease. A history of neck irradiation of cervical lymphadenopathy significantly increases the chance of thyroid malignancy, but other parameters of the history or physical examination as well as blood tests are unreliable. Ultrasound displays anatomic but not histologic features. X-ray techniques (plain films, computed tomographic scans, xeroradiography, chest x-ray, barium swallow, lymphography, and angiography) have been used to visualize thyroid nodules, with some techniques proving more useful than others.

The ultrasound of thyroid masses

Ultrasonography of the thyroid gland permits differentiation between cystic, solid, and mixed lesions, allowing conservative management of cystic lesions, which constitute 20% of hypofunctioning nodules. The combination of ultrasonography and fine needle aspiration cytology appears to be a great advance in the preoperative diagnosis of nontoxic goiter and permits individualized treatment in as precise a manner as is possible at present.