The relationship of primary tumor thickness in carcinoma of the tongue to subsequent lymph node metastasis

OBJECTIVES: To study whether primary tumor thickness of stage I/II tongue carcinoma provides information about subsequent lymph node metastasis. METHODS: Twenty consecutive patients with T1N0M0 or T2N0M0 tongue carcinoma were studied. Primary tumor thickness was measured with post-contrast helical computed tomography or intra-oral sonography. Cervical lymph nodes were evaluated periodically with sonography at intervals of 2-4 weeks. Sensitivity, specificity and accuracy for subsequent metastasis was calculated. RESULTS: Positive sonographic findings appeared in nine nodes of nine patients during this follow-up period. Eleven patients underwent neck dissections, and nine had histopathologically positive nodes. Nine patients had no sonographic findings of metastasis during a minimum follow-up period of 20 months. Primary tumor thickness varied from 3-16 mm. Using 5 mm as a cut-off thickness, the sensitivity, specificity and accuracy for subsequent lymph node metastasis were 64, 100 and 75% respectively. CONCLUSIONS: Patients with stage I/II tongue carcinoma which is more than 5 mm thick are more likely to develop lymph node metastasis.     

Combination of helical CT and Doppler sonography in the follow-up of patients with clinical N0 stage neck disease and oral cancer

BACKGROUND AND PURPOSE: Correctly diagnosing metastatic nodes is important for the follow-up of patients with clinical N0 stage neck disease and oral cancer. A combination of helical CT and Doppler sonography may facilitate the accurate detection of lymph node metastasis in patients with clinical N0 stage neck disease. METHODS: A combination of contrast-enhanced helical CT and Doppler sonography was performed to monitor the necks of 58 patients with initial clinical N0 stage neck disease. Of these patients, 17 underwent surgery; nodal metastasis in the neck was histopathologically confirmed. A node was diagnosed as metastatic if it fulfilled the CT criteria for metastatic nodes (short-axis diameter equal to or greater than the cutoff points for each level of the neck or central nodal necrosis) and if, additionally, it did not exhibit sonographic features for nonmetastatic nodes (normal hilar echogenicity and hilar flows). The presence of metastasis was confirmed histopathologically. RESULTS: During the follow-up periods, metastatic nodes were histologically confirmed in 17 (29%) patients. Of 30 metastatic nodes from the 17 patients with metastatic nodes, 22 (73%) appeared within the first year and 28 (93%) within the first 2 years; 20 developed from nonmetastatic nodes, and 10 were newly detectable. The combined criteria were effective in revealing 26 (87%) nodes, yielding 87% sensitivity, 100% specificity, and 100% positive and 99% negative predictive values. The independent use of one of these techniques alone resulted in low (67%) or moderate (87%) positive predictive values for sonography and CT, respectively. Seven hundred forty-one (97%) of 761 nodes that were nonmetastatic at initial examination remained nonmetastatic (737 nodes) or had disappeared (four nodes). As a result, a combination of CT and sonography was effective in revealing all 17 cases of metastatic nodes. CONCLUSION: A combination of contrast-enhanced helical CT and Doppler sonography is useful for the follow-up study of clinical N0 stage neck disease.     

Contribution of doppler sonography blood flow information to the diagnosis of metastatic cervical nodes in patients with head and neck cancer: assessment in relation to anatomic levels of the neck

BACKGROUND AND PURPOSE: Although sonographic evaluation of cervical adenopathy by use of size criteria is effective, the sensitivity and specificity fall short of that required to make adequate judgments regarding neck dissection. Therefore, we tested whether the combined use of size criteria and Doppler sonographic findings would improve the predictive ability for metastatic cervical nodes. METHODS: We analyzed 338 histologically proved cervical lymph nodes (108 metastatic and 230 nonmetastatic) in 73 patients with head and neck cancer. The sonographic topography of the nodes was compared with dissected specimens, and their position in the neck was categorized into three levels (I, II, and III+IV). The diagnostic accuracy of sonography was evaluated by using the single criterion of short-axis diameter of the node or by the combined criteria of short-axis diameter and Doppler blood flow features (the absence or presence of normal hilar flow). RESULTS: As compared with the single criterion of short-axis nodal diameter, the combined criteria of nodal size and Doppler blood flow patterns increased the diagnostic accuracy of sonography at all levels in the neck. Accordingly, the best cut-off values were improved to 6, 7, and 5 mm for nodes at levels I, II, and III+IV, respectively. In addition, the combined criteria yielded high sensitivites (> or = 89%) and specificities (> or = 94%). CONCLUSION: Hilar blood flow information obtained by Doppler sonography significantly improves diagnostic accuracy for the detection of nodes metastatic from head and neck squamous cell carcinoma.     

Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck

OBJECTIVE: We compared the ability of sonography and CT to differentiate benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. MATERIALS AND METHODS: We analyzed 209 cervical nodes (102 metastatic and 107 nonmetastatic) from 62 patients with head and neck cancer. These nodes were topographically correlated by node between images and surgical specimens, and accordingly between sonography and CT. RESULTS: The area under the receiver operating characteristic curve (A(z) value) for the overall impressions of metastatic or nonmetastatic nodes was significantly greater for sonography (power Doppler sonography plus gray-scale sonography, 0.97 +/- 0.005; gray-scale sonography, 0.95 +/- 0.004) than for CT (0.87 +/- 0.018). Receiver operating characteristic curve analysis also showed that the greater ability of sonography to depict the internal architecture of the nodes (A(z) value, 0.96 +/- 0.006) compared with CT (A(z) value, 0.81 +/- 0.027) significantly contributed to the better performance of sonography compared with CT in diagnosing metastatic nodes in the neck. On the other hand, size criterion (the short-axis diameter) was equally predictive in sonography and CT. The greater contributions of internal architectures relative to the size criterion of the node in the sonographic assessment for metastatic nodes were further evidenced by the findings that sonography provided higher sensitivity and specificity than CT did, whereas the cutoff points for the short-axis diameter in both tests were equivalent. CONCLUSION: Sonography performed significantly better than CT in depicting cervical metastatic nodes. Sonography could be a useful adjunct to CT in surveying cervical metastatic nodes.     

Sonographic detection of rotator cuff tears

Thirty-nine consecutive patients referred for shoulder arthrography underwent shoulder sonography to determine the ability of sonography to detect rotator cuff tears. Fifteen patients had arthrographically proven rotator cuff tears. Of these, 14 were detected by sonography, for a sensitivity of 93%. The three sonographic criteria indicative of rotator cuff tear were (1) discontinuity in the normal homogeneous echogenicity of the rotator cuff; (2) replacement of the normal homogeneous echogenicity by a central echogenic band; and (3) nonvisualization of the cuff. Twenty patients had normal sonographic examinations, 19 of which were normal by arthrography. Therefore, the predictive value of a negative sonogram was 95%. On the basis of these findings, sonography can provide a noninvasive means of screening patients with suspected rotator cuff tears.     

Invasion of the carotid artery and jugular vein by lymph node metastases: detection with sonography

Knowledge of invasion of the walls of the cervical vessels by tumor is of great clinical importance before surgery. We performed sonography on 83 patients with palpable cervical lymph node metastases in the region of the carotid bifurcation to determine the relationship of the metastases to the carotid artery and jugular vein. In all patients, the sonographic results were proved by surgery. The wall of the carotid artery was hypo-echogenic in 11 of 12 patients with surgically proved tumor invasion of the artery. Four results were false-positive. Palpation or swallowing during real-time scanning showed mobility of the tumor relative to the wall of the artery in 47 patients (57%). In these patients, tumor invasion could be excluded. Bilateral compression or invasion of the internal jugular vein was identified correctly with sonography in all five patients in whom this was confirmed surgically. These results suggest that real-time sonography is a valuable method for determining the relationship between cervical lymph node metastases and the carotid artery and jugular vein.     

Ultrasound of the neck

Sonography, when performed by an experienced examiner, can be used for evaluation of many pathologies in the head and neck area. Some benign neck lesions, such as cysts, lipomas, carotid body tumors, and hyperplastic lymph nodes, have typical sonomorphology. Sonography has an accuracy rate of about 90% in cervical lymph node staging and can delineate subclinical lymph node recurrences. It is the method of choice for evaluation of tumor infiltrations of the wall of the great vessels. Salivary gland tumors in the superficial lobe can be delineated completely by sonography. Salivary stones can be detected and localized. Carcinoma of the tongue and floor of the mouth with T1 and T2 staging can be assessed by US. The use and contribution of color Doppler sonography for the assessment of pathologic entities in the neck is a method under clinical investigation. US-guided fine-needle aspiration biopsy of lymph nodes and tumors of the salivary glands is easy to perform and is characterized by high sensitivity and specificity. To perform US examinations of the head and neck area of the highest quality the examiner should be familiar with the anatomy of the head and neck, be informed about the clinical problem, and have experience in the interpretation of abnormal US findings. US of the head and neck area is one of the most difficult sonographic examinations and should be performed by an experienced physician.     

Sonographic findings of the neopharynx after total laryngectomy: comparison with CT

BACKGROUND AND PURPOSE: To our knowledge, sonographic findings in the neopharynx have not been well characterized. We describe our results and assess the role of sonography versus CT in patients who have undergone total laryngectomy. METHODS: We examined 25 patients (24 men and one woman; 44-78 years old) who had had a total laryngectomy. Sonography (with a 10-MHz transducer) and contrast-enhanced CT were performed in all patients. We evaluated the normal shape of the neopharynx and assessed the accuracy of sonography versus CT in detecting tumor recurrence in the neck. RESULTS: The neopharynx appears as a round or ovoid structure on imaging studies. On sonograms, the neopharyngeal wall has five layers of alternating echogenicity: an innermost hyperechoic layer of superficial mucosa, an inner hypoechoic layer of deep mucosa, a middle hyperechoic layer of submucosa, an outer hypoechoic layer of muscle, and an outermost hyperechoic layer of adventitia. On CT scans, the neopharynx appears as a three-layered structure, with an inner hyperdense layer of mucosa, a middle hypodense layer of submucosa, and an outer isodense layer of pharyngeal constrictor muscles. Nine pathologically proved recurrences were found: three local recurrences, one local recurrence with lymph node metastasis, and five cases of lymph node metastasis only. One instance of false-negative lymph node metastasis was seen at sonography and one case of false-positive local recurrence was seen at CT. CONCLUSION: The neopharynx has a unique sonographic appearance, and this imaging technique is useful for detecting local tumor recurrence in the neopharynx in patients who have had a total laryngectomy.     

Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

OBJECTIVE: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. MATERIALS AND METHODS: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. RESULTS: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. CONCLUSION: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.     

Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis

BACKGROUND AND PURPOSE: Sonographic criteria of the lymph node have been found to be good indicators for metastatic lymph nodes. We determined which sonographic features are most predictive of metastasis in cervical lymph nodes among patients with head and neck cancer. METHODS: Gray-scale and power Doppler sonograms were retrospectively analyzed in 133 cervical lymph nodes (57 metastatic and 76 reactive nodes) from 52 patients with head and neck cancer. The gray-scale sonographic features of the presence or absence of hilar echoes, parenchymal echogenicity, and short and long axis lengths as well as the power Doppler features of normal hilar flow and abnormal parenchymal flow were evaluated. Univariate and multivariate logistic regression analyses were conducted to determine the relative value of each sonographic feature. RESULTS: At univariate analysis, all sonographic features assessed were found to be important. Multivariate analysis, however, suggested that the presence or absence of hilar echoes, increases in short axis length, and the presence of normal hilar flow were the only sonographic features that were predictive of reactive (presence of hilar echoes and hilar flow) and metastatic (increases in short axis length) lymph nodes. Although multivariate analysis did not indicate any significant contribution of the color-flow criteria for predicting metastatic nodes, the color-flow criteria appeared to improve the overall diagnostic accuracy for the less experienced observer. CONCLUSION: The sonographic criteria most predictive of metastatic cervical lymph nodes were absent hilar echoes and increases in short axis length, as assessed by logistic regression analysis. Compared with these gray-scale criteria, color-flow criteria had fewer predictive advantages.     

Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma

OBJECTIVE: The objective of this study was to evaluate the technique, efficacy, and side effects of percutaneous ethanol injection in patients with limited cervical nodal metastases from papillary thyroid carcinoma. SUBJECTS AND METHODS: Fourteen patients who had undergone thyroidectomy for papillary thyroid carcinoma presented with limited nodal metastases (one to five involved nodes) in the neck between May 1993 and April 2000. All patients had received previous iodine-131 ablative therapy with a mean total dose per patient of 7,548 MBq. Ten of the patients either were considered poor surgical candidates or preferred not to have surgery, and all were unresponsive to iodine-131 therapy. Each metastatic lymph node was treated with percutaneous ethanol injection, and patients received both clinical and sonographic follow-up. RESULTS: Twenty-nine metastatic lymph nodes in our 14 patients were injected. Mean sonographic follow-up was 18 months (range, from 2 months to 6 years 5 months). All treated lymph nodes decreased in volume from a mean of 492 mm(3) before percutaneous ethanol injection to a mean volume of 76 mm(3) at 1 year and 20 mm(3) at 2 years after treatment. Six nodes were re-treated 2-12 months after initial percutaneous ethanol injection because of persistent flow on color Doppler sonography (n = 4), stable size (n = 1), or increased size (n = 1). Two patients developed four new metastatic nodes during the follow-up period that were amenable to percutaneous ethanol injection. Two patients developed innumerable metastatic nodes that precluded retreatment with percutaneous ethanol injection. No major complications occurred. All patients experienced long-term local control of metastatic lymph nodes treated by percutaneous ethanol injection. In 12 of 14 patients, percutaneous ethanol injection was successful in controlling all known metastatic adenopathy. CONCLUSION: Sonographically guided percutaneous ethanol injection is a valuable treatment option for patients with limited cervical nodal metastases from papillary thyroid cancer who are not amenable to further surgical or radioiodine therapy.     

Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size

AIM: This study was undertaken to investigate variations in the vascularity and grey-scale sonographic features of cervical lymph nodes with their size. MATERIALS AND METHODS: High resolution grey-scale sonography and power Doppler sonography were performed in 1133 cervical nodes in 109 volunteers who had a sonographic examination of the neck. Standardized parameters were used in power Doppler sonography. RESULTS: About 90% of lymph nodes with a maximum transverse diameter greater than 5 mm showed vascularity and an echogenic hilus. Smaller nodes were less likely to show vascularity and an echogenic hilus. As the size of the lymph nodes increased, the intranodal blood flow velocity increased significantly (P < 0.05), whereas there was no significant variation in the vascular resistance(P> 0.05). CONCLUSIONS: The findings provide a baseline for grey-scale and power Doppler sonography of normal cervical lymph nodes. Sonologists will find varying vascularity and grey-scale appearances when encountering nodes of different sizes.Ying, M.et al. (2001). Clinical Radiology, 56, 416-419.     

Diagnostic accuracy of computed tomography for cervical metastases at different anatomical levels in carcinoma of the tongue

OBJECTIVES: To evaluate the variation in diagnostic accuracy of CT in the assessment of cervical lymph node metastases from tongue carcinoma at different anatomical levels. METHODS: Sixty-one patients with squamous cell carcinoma of the tongue who underwent radical neck dissection were included in this study. The CT and histopathological findings at nodal levels I-V were compared for the presence or absence of lymph node metastases. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of CT were evaluated for each nodal level. RESULTS: The sensitivity of CT was: level I, 85%; level II, 77.8%; level III, 53.3%; level IV, 66.7% and level V, 25%. There was a significant difference in the sensitivity between the level I-II group (80.9%) and level III-V group (53.6%) (P=0.012). There was no significant difference in the specificity, NPV, and PPV between the two groups. CONCLUSIONS: The sensitivity of CT in detecting cervical lymph node metastases was significantly smaller at levels III-V than at levels I-II.     

彩色多普勒超声评价肿瘤血管在甲状腺结节诊断中的应用

目的:研究甲状腺结节内肿瘤血管及颈部转移淋巴结的彩色多普勒超声表现。方法:分析42例甲状腺癌和46例甲状腺良性结节的血管形态及血流动力学特征。结果:甲状腺癌及甲状腺癌复发病例中,69.0%(29/42)血流为Alder2级或3级,38.1%(16/42)可见穿入性或分支异常的血管,71.4%(30/42)血流为高阻力型(RI>0.7)。甲状腺良性结节中,上述表现发生率分别为39.1%(18/46)、6.5%(3/46)、10.9%(5/46)。23例甲状腺癌可见颈部转移性淋巴结,其中82.6%(19/23)的血流形态表现为紊乱分布的包膜下血流。结论:甲状腺癌肿瘤血管的发现及颈部淋巴结的血流表现有助于甲状腺癌的正确诊断。     

Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors

OBJECTIVE: We determined whether contrast-enhanced color Doppler sonography can differentiate benign from malignant enlarged cervical lymph nodes in head and neck tumors. SUBJECTS AND METHODS: Ninety-four enlarged lymph nodes in 39 adult patients (32 men and seven women; age range, 30-81 years) were examined with B-mode sonography and with unenhanced and contrast-enhanced color Doppler sonography. All patients had carcinoma of the oral cavity. Histologically, lymphadenitis was found in 57 nodes and metastases in 37 nodes. Geometric dimension, texture, and margin of the node and detection and location of vessels were noted. Histology and imaging findings were correlated. RESULTS: The transverse-to-longitudinal diameter ratio in combination with texture and margin analysis resulted in a correct diagnosis in only approximately 79% of the nodes. With contrast-enhanced color Doppler sonography, 86% of nodes showed vessels, and 28% of nodes showed vessels with this technique exclusively. Characteristic configurations were identified: hilar vessels with branching indicated lymphadenitis (sensitivity, 98%; specificity, 100%), and predominantly peripheral vessels indicated metastases (100%, 98%). These findings changed the diagnosis in 13 nodes, changed the therapy in four patients, and led to an incorrect diagnosis in one patient. CONCLUSION: Enlarged lymph nodes can be characterized as metastatic or inflammatory with high diagnostic accuracy on the basis of their vascular architecture as seen on contrast-enhanced color Doppler sonography.     

Intraoral sonographic features of tongue cancer after radical radiotherapy

PURPOSE: The purpose was to illustrate the sonographic changes of tongue cancer after radical radiotherapy. MATERIALS AND METHODS: In 24 patients with tongue cancer treated by interstitial brachytherapy (BRT) (uneventful recovery n = 16 , recurrence n = 5, severe soft tissue complication n = 3), follow-up examination were performed and both the margin and the vascular pattern were retrospectively assessed. We basically performed US examination at least once every 3 months after BRT within 1 year during follow-up period. RESULTS: In the healing process, intraoral sonography shows an unclear margin immediately after brachytherapy and a transient increase of the vascularity lasted within 6 months after BRT, followed by a decrease in the vascularity. The large difference in echogenicity between the primary site and the surrounding tissue and the increased difference suggested the possibility of either radiation ulceration or recurrence. CONCLUSION: Intraoral sonography could depict the sequence changes of the tongue after BRT, and it was thus useful to confirm the clinical findings of either radiation ulcers or recurrence.     

Tumor thickness and paralingual distance of coronal MR imaging predicts cervical node metastases in oral tongue carcinoma

BACKGROUND AND PURPOSE: The presence of cervical lymph node metastases is an important prognostic factor for oral tongue cancer. The accurate preoperative assessment is essential for treatment. Several studies have suggested that histologic tumor thickness is related to the metastases. The aim of this study was to determine whether MR images of oral tongue tumor have the potential to predict cervical lymph node metastases.MATERIALS AND METHODS: A total of 43 patients with squamous cell carcinoma of the oral tongue were investigated. Tumor thickness, sublingual distance between tumor and sublingual space, and paralingual distance between tumor and paralingual space, as determined from coronal MR imaging, were preoperatively estimated. Logistic regression analysis was used to identify independent predictors of lymph node metastases.RESULTS: Univariate logistic regression analysis showed that T classification, N classification, and 3 measured MR imaging distances (millimeters) were significantly associated with lymph node metastases. Multivariate logistic regression analysis showed that tumor thickness (odds ratio, 1.34; 95% confidence interval [CI], 1.11–1.63; P < .005) and paralingual distance (odds ratio, 0.53; 95% CI, 0.35–0.82; P < .005) were significant predictors for lymph node metastases. The probability of metastases was estimated with these models. The preoperative decision (20% probability) as to whether to perform neck dissection could be based on tumor thickness of >9.7 mm and paralingual distance of <5.2 mm.CONCLUSION: MR images provide satisfactory accuracy for the preoperative estimation of the tumor thickness and the paralingual distance, which are valuable for predicting cervical lymph node metastases.

Squamous cell carcinoma (SCC) of the oral tongue has a relatively high propensity for cervical lymph node metastases, which ranges 37%–58%.^1,2 The presence of cervical lymph node metastases is the most important prognostic factor for survival.^3–5 Clinical assessment of the neck is an essential part of the examination. Advances in imaging techniques such as CT, MR imaging, and sonography have improved the accuracy of detection of cervical lymph node metastases, but patients with N0 classification may still harbor occult metastases. The incidence of occult metastases varies from 20% to 50%,^1,2,6–10 and the management of the clinically negative (N0) neck remains a controversial issue. Several studies have suggested that histologic tumor thickness is related to cervical metastases of oral tongue cancer.^2,10–18 This finding indicates that presurgical determination of tumor thickness might be useful for neck treatment planning. More recent studies have demonstrated that tumor thickness on MR imaging directly correlates with histologic thickness.^19–21 MR imaging thickness in patients with metastatic lymph nodes tended to be greater than that in metastases-free patients, though the difference was not significant between patients with and without metastasis.²¹ Tongue carcinoma varies in the tumor shape (reductive or expansive) and in the growth pattern (endophytic or exophytic). Therefore, how far tumor cells invade and which structures these cells infiltrate, rather than tumor thickness, may be important. The surface epithelium on the lateral side of the tongue is supported by submucosa; underlying the submucosa are intrinsic tongue muscles. The sublingual space is below the intrinsic tongue muscles and contains the sublingual gland. The genioglossus muscle lies medial to the sublingual space and the paralingual space, between the genioglossus and the intrinsic tongue muscles. Therefore, the distances between these spatia and tumor might be a more reliable predictor for lymph node metastases than tumor thickness.We performed a retrospective study of the ability of preoperative MR images to estimate the tumor thickness and the distances between the tumor and the sublingual/paralingual space, and we assessed the relationship between these variables and cervical lymph node metastases.     

Computed tomography and sonographic findings of hepatic metastases from gastrointestinal stromal tumors after chemotherapy

OBJECTIVE: The purpose of this study was to evaluate the computed tomography (CT) and sonographic findings in patients with hepatic metastases from gastrointestinal stromal tumors (GISTs) after STI-571 treatment. METHODS: Computed tomography and sonographic findings of 8 lesions in 6 patients with hepatic metastases from GISTs that were treated with STI-571 were retrospectively analyzed. The change in size, attenuation, and echogenicity of the hepatic metastases from GISTs after STI-571 treatment was evaluated. RESULTS: After treatment with STI-571, the hepatic metastases were decreased in size and the attenuation of the hepatic metastases was homogeneously hypodense on CT. Sonography revealed the hepatic metastases to be centrally cystic with a thin wall (n = 4) or predominantly solid (n = 4) after STI-571 treatment. On color Doppler sonography, no blood flow was identified within the solid portion of the mass. CONCLUSION: After treatment with STI-571, although the hepatic metastases from GISTs exhibit a cystic appearance on CT, they may appear as solid masses on sonography.     

Cystic lymph node metastases in papillary thyroid carcinoma

OBJECTIVE: The aim of this study was to illustrate and discuss the sonographic spectrum of surgically proven cystic nodal metastases from papillary thyroid carcinoma. By correlative evaluation of the sonographic imaging findings to gross pathology and histology, our purpose was to provide useful hints to differentiate cystic lymph node metastases from other benign cystic neck lesions such as branchial cysts. MATERIALS AND METHODS: Sonographic examinations of 74 patients (47 women, 27 men; mean age, 49 years) with 97 histologically confirmed cystic lymph nodes metastases from papillary thyroid carcinoma were included in the study. The anatomic relationship of the nodes relative to the primary tumor was recorded, and all cystic nodes were qualitatively categorized as either simple (purely cystic) or complex (thickened outer wall, internal nodules, internal septations, and calcifications). All imaging findings were compared with gross pathologic specimens. RESULTS: Most of the cystic metastases were ipsilateral to the primary tumor (87.8%) and located in the mid or lower jugular chain (73.2%). In 14.9% of all patients, cystic lymph node metastases were the initial manifestation of disease. Only 6.2% of all lymph node metastases were purely cystic (all of these occurred in patients less than 35 years old). Of the 91 complex metastases, a thickened outer wall was present in 35.2% of patients, internal nodules in 42.9%, and internal septations in 57.1%. No calcifications were seen in the 91 complex metastases, and two or more findings were seen in 23.1%. All sonographic findings were verified by surgery. CONCLUSION: In most of the patients, cystic lymph node metastases are characterized sonographically by the presence of a thickened outer wall, internal echoes, internal nodularity, and septations. However, in younger patients, the lymph nodes might appear purely cystic, thereby mimicking branchial cysts and thus requiring biopsy for final diagnosis and therapy planning.     

The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it?

PURPOSEA definition of cut-off points for nodal size is essential to determine whether cervical lymph nodes are metastatic or not. Because the currently used size criteria are defined for random populations of patients with head and neck cancer, we set out to study whether these criteria are optimal for patients without palpable metastases in different levels of the neck We defined optimal size criteria for sonography by calculating the sensitivity and specificity of different size cut-off points.METHODSWe compared the sensitivity and specificity of different size cut-off points as measured on sonograms for various levels in the neck in a series of 117 patients with and 131 patients without palpable neck metastases.RESULTSA minimum axial diameter of 7 mm for level II and 6 mm for the rest of the neck revealed the optimal compromise between sensitivity and specificity in necks without palpable metastases. For all necks together (with and without palpable metastases), the criteria were 1 to 2 mm larger.CONCLUSIONOur findings indicate that the current sonographic size criteria used for random patient populations are not optimal for necks without palpable metastases, nor can the same cut-off points be used for all levels in the neck.