Efficiency of ultrasonography in assessing cervical lymph node metastasis in oral carcinoma

The applications of ultrasound, and ultrasonography in dentistry: a scoping review of the literature

OBJECTIVES

This scoping review aims to summarize the available literature on the clinical applications of ultrasonography and ultrasound in diagnostic, therapeutic, and interventional dental applications.

MATERIALS AND METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for Scoping Reviews checklist and conducted a protocol-driven scoping review of randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, and case series that assessed ultrasonography or ultrasound use as a stand-alone diagnostic, therapeutic, and interventional tool in dentistry. We included studies published after 1980, study samples ≥ 10, with diagnostic, concordance, or therapeutic outcomes. We searched Ovid MEDLINE, Embase, and others (up to April 2021) and extracted information regarding study level, patient level, test or treatment level, and outcome level data.

RESULTS

Five interventional studies (related to oral medicine, temporomandibular disorders, and dental anesthesia), eight therapeutic studies (related to surgery and orthodontics), and seventy-five diagnostic studies (related to orthodontics, surgery, endodontics, oral medicine, temporomandibular disorders, restorative dentistry, and periodontology) were identified and presented in this review.

CONCLUSION

Ultrasonography has a well-established niche in diagnostic dentistry, while therapeutic and interventional ultrasounds have a smaller, yet present, niche in dentistry. However, further research is needed to report the precise estimates of the diagnostic, therapeutic, and interventional effects.

CLINICAL SIGNIFICANCE

Dentists are mostly unfamiliar with ultrasonography and ultrasound and their potential uses. This review maps the diagnostic and therapeutic applications of ultrasonography and ultrasound technology in dentistry and highlights the current challenges, gaps of knowledge, and research status of ultrasound technology in this regard.

In vitro Comparison of Cone Beam Computed Tomography and Ultrasonography Imaging Methods in the Evaluation of Artificial Mandible Intraosseous Lesions

Statement of the Problem:

Intraosseous lesions of jaws can be imaged by cone beam computed tomography (CBCT) and ultrasonography (USG). The knowledge of imaging features of these two methods about intraosseous jaw lesions is important for dental radiology.

Purpose:

The aim of this study is to evaluate artificial mandible intraosseous lesions by using CBCT and USG.

Materials and Method:

In this in vitro study, intraosseous lesions containing water, milk, olive oil, and liver were evaluated in 60 artificial mandibles by using CBCT and USG. Lesion sizes were compared between CBCT and USG. Lesion sizes were measured on the anterior-posterior, bucco-lingual, and superior-inferior sides. Hounsfield unit (HU) values of the lesions in CBCT images were compared between different materials. Echogenicity of the lesions were evaluated in USG images. One sample t and one-way Anova tests were used for the statistical analysis of the study (p< 0.05).

Results:

In all size measurements of the lesions, mean CBCT values were statistically higher when compared with USG. In CBCT images, statistically difference was found between the HU values of lesions containing olive oil and other lesion contents. In USG images, echogenicity of water, milk and olive oil was found to be anechoic and the echogenicity of liver was found to be hypoechoic.

Conclusion:

CBCT was found to be more accurate than USG in measurement of the size of mandibular intraosseous lesions. According to the results of our study, it was thought that only oil content could be differentiated by using CBCT HU values. It was found that lesions with liquid and non-liquid contents could be differentiated with their echogenicity difference in USG images.

Efficacy of Computed Tomography and Ultrasonography in Diagnosis of Metastatic Cervical Lymph Nodes in Orofacial Cancer

INTRODUCTION

There is no consensus on which imaging modality is better for the detection of metastatic cervical lymph nodes in orofacial malignancies. This study evaluates the efficacy of computed tomography (CT) and ultrasonography (US) in diagnosis of metastatic cervical lymph nodes in orofacial cancer.

MATERIALS AND METHODS

Sixty patients with various histologically diagnosed orofacial malignant lesions and clinical evidence of cervical lymph node metastasis were examined using US and CT. Further, the affected lymph nodes were biopsied and examined histologically. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the techniques were calculated. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05.

RESULTS

US recorded a sensitivity, specificity, PPV, NPV, and accuracy of 80.0%, 57.1%, 77.5%, 60.0%, and 71.7%, respectively (P = 0.004), while CT recorded a sensitivity, specificity, PPV, NPV, and accuracy of 87.1%, 71.4%, 85.0%, 75.0%, and 81.7%, respectively (P< 0.0001). Lymph node size was the commonest criterion in the diagnoses of metastases in cases with cervical lymph nodes.

CONCLUSION

Although we obtained great results using US, our results indicated CT to be a better imaging modality for detecting metastatic cervical lymph nodes in orofacial malignancies.

Is Acoustic Radiation Force Impulse (ARFI) Ultrasound Elastography Valuable in the Assessment of Cervical Lymphadenopathy?

Cervical lymphadenopathy frequently poses a diagnostic challenge as neither clinical nor imaging assessment can reliably differentiate between benign and malignant lymphadenopathy. Non-invasive differentiation between the two may help to reduce the number of FNAC or biopsy. The purpose of this study was to evaluate whether the new ARFI technique (Virtual Touch Quantification), in conjunction with gray scale sonography and Doppler, can help in the characterization and differentiation of benign from malignant cervical lymphadenopathy. Fifty adult patients with cervical lymphadenopathy were included in the study and sonoelastography was done. Sonoelastographic findings were compared to the gold standard histopathology or cytopathology. ARFI measurements in benign and malignant enlarged lymph nodes were compared using the Student t test and ROC curve was used to arrive at the Youden index, sensitivity, specificity, PPV, NPV and diagnostic accuracy. Sonographic patterns indicative of malignancy includes heterogenous echopattern, short axis/long axis ratio > 0.5, absent echogenic fatty hilum and mixed vascular pattern. Sensitivity, specificity, PPV, NPV and accuracy in differentiation between the benign and malignant lymph nodes using ARFI elastography was 79.17, 100, 100, 83.9 and 89.9% respectively. ROC curve analysis of SWVs for differentiation between the malignant and benign lymph nodes gave a cut-off value of 2.8 m/s with an area under curve of 0.892. ARFI imaging technique quantifies the tissue stiffness of the cervical lymph nodes non-invasively and aids in characterisation and differentiation of benign from malignant cervical lymphadenopathy in conjunction with conventional sonography.

Efficiency of Ultrasonography in Swellings of Orofacial Region

Introduction

Ultrasonography (USG) is found to be important in identifying various soft-tissue pathologies in the orofacial region. Therefore, its features should be studied and documented in these lesions so that a more appropriate provisional diagnosis can be made.

Aim

This study aims to study ultrasonographic features in various kinds of swellings in the orofacial region.

Materials and Methods

The study grouped consists of 30 patients of both sexes (20 males and 10 females) with an age range of 15-70 years complaining of swellings in the orofacial region. All the patients in the study were explained the need of tests and subjected to clinical, ultrasonographic, and histopathologic examination. Sonosite Micromaxx sonography machine was used with a linear array transducer of 13-6 MHz frequencies. Ultrasonographic diagnosis is then correlated with clinical and histopathologic diagnosis. Chi-square test and contingency coefficient tests were used.

Results

A significant association was observed between clinical and ultrasonographic diagnoses (contingency = 0.872, P < 0.05) and between ultrasonographic and histopathologic diagnoses (contingency = 0.904, P < 0.05). There was 100% congruency between clinical diagnosis and ultrasonographic diagnosis in all the cases except in cases of cysts, abscess, and sialadenitis. Reliability of USG was found to be 97% in diagnosing all the cases with respect to histopathological diagnosis, while it was 90% with respect to clinical diagnosis.

Conclusion

USG was found to be a reliable diagnostic modality in the diagnosis of orofacial swellings.

Diagnostic accuracy of high resolution ultrasound to differentiate neoplastic and non neoplastic causes of cervical lymphadenopathy

INTRODUCTION

Lymph nodes are normal structures distributed throughout the human body and are enlarged in various disease entities. Identifying the relevant lymph nodes is important in treating these patients. High resolution sonography (HRSG) and fine needle aspiration cytology (FNAC) play crucial role in planning the treatment.

OBJECTIVE

To assess the diagnostic accuracy of HRSG differentiate neoplastic and non neoplastic causes of enlarged cervical lymph nodes.

MATERIALS AND METHODS

HRSG evaluation of enlarged cervical lymph nodes were performed to differentiate neoplastic from non neoplastic lymph nodes followed by FNAC correlation and the accuracy of HRSG was studied.

RESULTS

One hundred and fourteen lymph nodes of 106 patients were analysed to accomplish the study objective. In our study, HRSG had 96% sensitivity and 90.6% specificity for differentiating between neoplatic and non-neoplastic cervical lymphadenopathy. Similarly positive and negative predictive values were 88.9% and 96.7% respectively. Overall accuracy of HRSG was 93%.

CONCLUSION

Owing to high sensitivity and negative predictive value, HRSG with Doppler is an excellent first line investigating tool for enlarged lymph nodes and avoids invasive procedures like FNAC in cases of reactive/ inflammatory (non-neoplastic) lymph nodes. However, neoplastic diagnosis of HRSG needs further confirmation by FNAC.