Ultrasonography-guided fine-needle aspiration for the assessment of cervical metastases

OBJECTIVE: To assess the value of ultrasonography (US) combined with fine-needle aspiration (FNA) cytology for the investigation of lymph node metastases in patients with head and neck cancer. DESIGN: Comparison of clinical examination (palpation) and preoperative US-FNA examination results of cervical nodes in a sample of patients with head and neck cancer. The histological features of the neck dissection specimens are used to validate these 2 variables. SETTING: A head and neck oncology service in a tertiary referral hospital. PATIENTS: A consecutive sample of 56 patients with head and neck squamous cell carcinoma, first seen between April 1, 1996, and July 30, 1998, who had neck dissections performed after the US-FNA examination. INTERVENTION: Cervical US-FNA preoperatively, followed by elective or therapeutic radical modified or selective neck dissection. MAIN OUTCOME MEASURES: The histological examination results of subsequent neck dissection specimens are used to determine the sensitivity, specificity, and accuracy of US-FNA for individual nodes. Second, the results of node staging by clinical examination and US-FNA examination are compared. RESULTS: The sensitivity was 89.2%; specificity, 98.1%; and accuracy, 94.5%. Correct node stages were obtained in 52 (93%) of the patients using US-FNA compared with 34 (61%) using palpation. CONCLUSIONS: Ultrasonography combined with FNA is a highly accurate technique for the investigation of cervical lymph node metastases. A more accurate diagnosis may result in more appropriate treatment, particularly in a setting with limited resources. Retropharyngeal nodes, micrometastases, and lymph nodes smaller than 4 mm are limitations of US-FNA. Ultrasonography combined with FNA is a useful technique for the staging of head and neck cancer.     

A clinical study of ultrasonography for lymph node metastases in head and neck cancer

Ultrasonography (US) is very useful in evaluating cervical lymph node swelling in head and neck cancers. We studied problems with US in evaluating lymph nodes. Cervical lymph nodes were removed by radical neck dissection or modified radical neck dissection from 79 patients with squamous cell carcinoma in the head and neck. We studied the correlation between preoperative US findings and the histopathological features. Preoperative lymph nodes were measured three-dimensionally. We diagnosed lymph nodes as metastases when they meet two criteria: One is the shortest diameter exceeding 7 mm in level I and II and 6 mm in level III, IV and V. The other is shortest to longest diameter ratio exceeding 0.5. A total of 2004 lymph nodes were removed by neck dissection, and 199 lymph nodes were diagnosed histopathologically as metastases. Of the 199 metastatic lymph nodes, 93 (46%) were diagnosed as metastases by preoperative US findings and 33 (17%) were false negative. Thirty-six cases were diagnosed preoperatively as N0 by US findings, but 15 of these were pN(+) histopathologically. In the 15 cases, 21 lymph nodes were metastases. Of the 21 metastatic lymph nodes, 10 nodes were not detected by US. Thirty-one cases were diagnosed preoperatively as N1 by US findings, but 20 of these were pN2b histopathologically. In the 20 cases, 66 lymph nodes were metastases. Of the 66 metastatic lymph nodes, 46 were not diagnosed as metastases. They often located distant level from the lymph node diagnosed correctly as a metastasis. US is very useful in evaluating cervical lymph node metastasis, but it has the limitations indicated above. If 1 metastatic lymph node is detected by US, there will be multiple metastatic lymph nodes and sometimes they are distant from the original level. Radical neck dissection should be done for positive lymph nodes detected by US findings. If a lymph node is not clearly a metastasis, fine-needle aspiration cytology (FNA) should be done, because it provides more accurate diagnosis for metastatic lymph nodes.     

头颈部鳞癌颈淋巴结隐匿性转移

目的 探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法 对111例头颈部鳞癌N_0M_0患者的颈淋巴结清扫标本进行切片观察。结果 隐匿性转移总体发生率为26.12％(29/111)。其中口腔癌18.75％(15/80),口咽癌25.00％(1/4),下咽癌54.54％(6/11),喉癌43.75％(7/16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N_0M_0患者5年生存率为66.7％,其中pN~-为74.39％(61/82),pN~ 为44.82％(13/29)。结论 对临床T_3和T_4期、癌组织分化程度低和深度浸润的cN_0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma

The value of ultrasound in detecting central compartment lymph node metastasis in patients with well-differentiated thyroid carcinoma (WDTC) is unclear. Prospective patients with WDTC attending a university-affiliated tertiary medical center between July 2010 and June 2011 underwent neck ultrasound for detection of central compartment lymph node metastases prior to surgery. Central lymph node dissection was performed during the initial surgery regardless of ultrasound findings. The sensitivity and specificity of preoperative ultrasound in detecting central lymph node metastases were calculated according to the final histopathological results. Sixty-four patients met the study criteria. Twenty-four had pathologic central compartment lymph nodes according to preoperative ultrasound, 20 of which were confirmed by histological examination. One patient was found to have pathological central lymph nodes by histology which was not detected by US. Sensitivity of preoperative ultrasound was 95 %, specificity 90 %, and negative and positive predictive values 97 and 83 %, respectively. Preoperative ultrasound may serve as an accurate and important tool for deciding the extent of surgery in WDTC.     

Diagnosis of cervical lymph node metastases in head and neck cancer with ultrasonic measurement of lymph node volume

ObjectiveThe purpose of this study was to evaluate the usefulness of ultrasound (US) volume measurement of the cervical lymph nodes for diagnosing nodal metastasis in patients with head and neck cancer using a node-by-node comparison.MethodsThirty-four consecutive patients with head and neck cancer from one tertiary university hospital were prospectively enrolled from 2012 to 2017. Patients with histologically proven squamous cell primary tumors in the head and neck region scheduled to undergo a therapeutic neck dissection were eligible. For each patient, 1–4 target lymph nodes were selected from the planned neck dissection levels. Lymph nodes with thickness >20 mm or in a cluster were excluded. Node-by-node comparisons between the pre-operative US assessment, the post-operative actual measurements and histopathological results were performed for all target lymph nodes. Quantitative measurements, such as three diameters, ratios of the three diameters and volume were analyzed in this study. Lymph node volume was calculated using the ellipsoid formula.ResultsPatients comprised 28 men and 6 women with a mean age of 60.0 years (range, 29–80 years) at the time of surgery. In total, 67 target lymph nodes were analyzed in this study and the thickness ranged from 3.9 to 20.0 mm (mean 8.0 mm). There was a strong correlation between the US volume and post-operative actual volume (ρ = 0.87, p < 0.01). The US volume measured 2156 ± 2156 mm³ for the tumor positive nodes, which was significantly greater than the US volume of 512 ± 315 mm³ for tumor negative nodes (p < 0.01). Significant differences between tumor positive and tumor negative nodes were found in five variables (volume, thickness, major axis, minor axis and ratio of minor axis to thickness) for total lymph nodes. To identify predictors of lymph node metastasis, ROC curves of the US variables of target lymph nodes were compared, of which 4 variables were considered acceptable for predicting the lymph node metastasis: volume (AUC 0.86), thickness (AUC 0.86), major axis (AUC 0.79), and minor axis (AUC 0.79) for total lymph nodes. The optimal cut-off level for US volume in total lymph nodes was found to be 1242 mm³, whereby a 62% sensitivity and 98% specificity was reached (likelihood ratio: 25.2).ConclusionPre-operative ultrasonic volume measurement of the cervical lymph nodes was useful for early detection of cervical nodal metastasis in head and neck cancer.     

下咽癌颈淋巴结转移的临床病理学特点及其对预后的影响

目的探讨影响下咽癌颈淋巴结转移的临床病理因素和颈淋巴结转移对预后的影响。方法采用X^2检验和Logistic回归分析，对98例下咽癌患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究。并对颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结数目、转移颈淋巴结累及区域数、转移颈淋巴结最低受累区域等淋巴结病理学因素对生存率的影响，进行Cox回归分析。结果下咽癌患者5年生存率为28．6％。单因素和多因素分析均证实，肿瘤生长方式、肿瘤大小与发生颈淋巴结转移关系密切。而肿瘤突破基底膜达黏膜下层后对下咽癌颈淋巴结转移发生率不再产生进一步影响。Cox回归分析表明，临床N分期、颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结最低受累区域因素影响患者生存率，特别是转移颈淋巴结大小、转移颈淋巴结最低受累区域因素与下咽癌患者生存率明显相关。结论下咽癌颈淋巴结转移是影响患者预后的重要因素，预测下咽癌颈淋巴结，对其作出早期正确诊断，并对影响预后的淋巴结因素采取相应治疗措施是提高下咽癌治疗效果的关键。     

Comparative studies of diagnosis with US or CT of the cervical lymph node metastases in head and neck cancer

Correct assessment of lymph node metastasis in the head-neck region is very important for management of head and neck cancer. 233 lymph nodes were removed by radical neck dissection from 12 cases with cancer in the head and neck region, who did not undergo any preoperative treatment, and the materials were histopathologically examined. The histopathological findings were compared with preoperative US and CT findings. Histopathologically, 26 lymph nodes were found positive for metastasis and the remaining 207 lymph nodes, negative. US detected 45 (19%) of 233 lymph nodes before operation, and 40 of the 45 lymph nodes (89% : 40/45) were qualitatively correctly diagnosed. CT detected 21 lymph nodes (19%), 16 of which were qualitatively correctly diagnosed (76% : 16/21). Of 26 lymph nodes which were histopathologically involved, 19 lymph nodes were correctly diagnosed by US and 11 by CT. Possible reasons explaining the superiority of US to CT in terms of diagnostic reliability are the following: 1) US demonstrates more clearly the existence of lymph nodes than CT. 2) US is more reliable for measuring sizes of lymph nodes than CT. In literature, CT has been often reported to be useful to diagnose cervical lymph node involvement in individual cases. However, we insist that it is necessary to diagnose individual lymph nodes strictly for correct assessment of the reliability of image diagnosis.     

声门上型喉癌颈淋巴结转移方式及其对预后的影响

目的：探讨影响声门上型喉癌颈淋巴结转移的临床病理因素及颈淋巴结转移对预后的影响。方法：用x^2检验和Logistic回归分析，对55例声门上型喉癌患者的肿瘤临床病理学因素与颈淋巴结转移的关系进行回顾性分析；并对颈淋巴结转移状态，转移颈淋巴结大小、数目、累及区域、最低受累区域等病理学因素对预后的影响进行Cox回归分析。结果：单因素分析显示，肿瘤病理分级、肿瘤大小、肿瘤浸润深度与发生颈淋巴结转移有关；多因素分析显示，肿瘤病理分级、肿瘤大小与发生颈淋巴结转移明显相关；声门上型喉癌患者5年生存率为52．7％。Cox回归分析表明，临床N分期、颈淋巴结转移状态、转移颈淋巴结大小影响患者预后。结论：声门上型喉癌颈淋巴结转移的发生受原发癌病理学因素的影响，它从多个角度明显影响患者预后；对影响预后的淋巴结因素采取相应治疗措施，对提高声门上型喉癌的治疗效果具有重要意义。     

CT诊断头颈癌颈淋巴结转移的病理学基础

为研究ＣＴ诊断颈淋巴结转移的病理科基础，应用双盲法对行颈廓清术的２２例（２６侧）头颈癌患者术前的触诊、病理学、ＣＴ扫描特征的相关性进行对比研究。资料显示：２６例中，１６例ＣＴ扫描阳性，其中１例为假阳性，１０侧阴性，其中１侧为假阴性。ＣＴ扫描的敏感性、特异性、准确率分别为９３．８％、９０．０％、９２．３％。并就头颈部鳞癌转移淋巴结ＣＴ影像的诊断标准和相应的病理学特征，以误诊、漏诊的原因进行讨论。     

Level IIb lymph node metastasis in thyroid papillary carcinoma

The objective of the study was to evaluate the incidence of level IIb lymph node metastases in neck dissections for thyroid papillary carcinoma (TPC) patients. 47 neck dissections of 33 patients with TPC were prospectively evaluated. Selective neck dissections (levels II, III, IV, and V) were performed in all cases. If level I lymph node metastasis was suspected during the procedure, level I dissection was also performed. All level IIb specimens were sent separately from the remainder of the neck dissection for the pathological examination. The number of dissected and metastatic lymph nodes in each specimen was recorded. Twenty-two of 47 neck dissections (46.8%) were positive for the lymph node metastasis. Among 47 neck dissection specimens, the incidence of lymph node metastasis at level II was 12.7% (6 of 47) and level IIb was 2.1% (1 of 47). The rate of level IIb lymph node involvement among patients with metastatic cervical lymph nodes was 4.5% (1 of 22). The specimen with metastatic lymph node at level IIb had also metastasis at levels IIa, III, IV, and V. The results of the present study suggested that lymph node metastases in level IIb are rare in patients with TPC undergoing neck dissection.     

Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck

Although computed tomography and magnetic resonance imaging have contributed to the ability to identify metastatic disease in head and neck Cancer, inadequacies in evaluating lymphadenopathy still exist. This study was undertaken to estimate the accuracy of radiological criteria used to detect cervical lymph node metastases. The morphological characteristics of 957 lymph nodes from 36 neck dissections from patients with squamous cell Cancer were examined microscopically. A large number of malignant nodes were found to have diameters of less than 10 mm. Extranodal spread also occurred in a substantial percentage of smaller nodes. Because the present radiological criteria for assessing cervical lymph node Status are based largely on size, findings indicate major limitations in the capabilities of detecting metastatic disease. New modalities to improve the Staging of head and neck Cancer are discussed.     

Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients

OBJECTIVES/HYPOTHESIS: The objectives were to quantify the incidence of clinically unsuspected thyroid tissue in cervical lymph nodes encountered during neck dissection in patients with head and neck carcinoma, to describe the location and histological aspect of these inclusions, and to assess their clinical significance. STUDY DESIGN: Retrospective study. METHODS: The histological records of 1123 neck dissections in 752 patients with head and neck carcinoma were reviewed. In cases with thyroid inclusions, the pathological diagnosis was reviewed and an immunohistochemical study against thyroglobulin and calcitonin was carried out. RESULTS: Clinically unsuspected thyroid tissue was found in lymph nodes in 11 of the 752 patients with head and neck carcinoma treated with neck dissection. In five cases, the thyroid inclusion was compatible with a metastases of an occult papillary thyroid carcinoma. In the other six cases, a collection of thyroid follicles without malignant characteristics was found beneath the lymph node capsule. These latter cases were considered benign thyroid inclusions. A thyroidectomy was performed in three of the patients with lymph node metastases of the papillary carcinoma. An occult papillary carcinoma was found in only one case. The other two patients had been treated previously with radiotherapy for an early-stage glottic carcinoma. Immunohistochemical study did not find calcitonin-positive cells within the benign thyroid inclusions. After a follow-up period ranging from 1.2 to 8.2 years, no patient had any kind of local, regional, or distant relapse related to the thyroid disease. CONCLUSION: The incidence of unsuspected thyroid tissue in lymph nodes of patients with head and neck carcinoma treated with neck dissection was 1.5%. Both lymph node metastases of a papillary carcinoma and benign thyroid inclusions were found. The study results suggest that the incidental finding of thyroid tissue in the lymph nodes during a neck dissection in patients with head and neck carcinoma does not necessarily indicate the need for aggressive therapy.     

Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study

Summary Although palpation has proved to be an unreliable staging procedure, the indications for and the implications of more reliable radiologic staging methods for the neck in patients with a primary squamous cell carcinoma of the head and neck remain controversial. Only a very accurate imaging technique can replace neck dissection in clinical NO disease. This study compares the value of palpation with computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) with or without guided aspiration cytology for neck node staging. One hundred and thirty-two patients with squamous cell carcinoma of the head and neck were examined radiologically before undergoing a total of 180 neck dissections as part of their treatment. CT, US and MRI proved to be significantly more accurate than palpation for cervical lymph node staging. The accuracy of US-guided aspiration cytology was significantly better than of any other technique used in this study. Modern imaging techniques are essential for appropriate assessment of neck node metastases. In view of advances in the accuracy of contemporary imaging, the need for elective treatment of the neck requires reappraisal.     

Diagnostic role of ultrasound elastography on lymph node metastases in patients with head and neck cancer

IntroductionUltrasonography is the easiest non-invasive method to diagnose lymph node metastases in patients with head and neck cancer. However, since CT scans are often preferred in the evaluation of primary tumours of these patients, information about lymphatic metastases may also available in these patients. Therefore, ultrasound is not routinely employed in the evaluation of these patients. However, elastography technique, a recent development in ultrasound technology, could make use of ultrasonography in these patients even more widespread, even though it is still not widely used today.ObjectivesThe aim of this study was to evaluate the role of sonographic elastography in the diagnosis of lymph node metastasis of head and neck cancer.MethodsTwenty-three patients diagnosed with head and neck cancer and scheduled for surgical treatment including neck dissection were included in the study. All patients underwent neck examination by palpation, ultrasound elastography and computerized tomography with contrast. To compare the diagnostic performance of palpation, ultrasound elastography and computerized tomography, the findings of each examination method were compared with the histopathological examination results of neck specimens.Results15 (65.2%) patients had a primary tumour in the larynx; 7 (30.4%) in the oral cavity; and 1 (4.3%) in the parotid. 7 (30.4%) out of 23 patients underwent bilateral neck dissection. In total, 30 neck dissections were hereby taken into account during study. Ultrasound elastography showed higher accuracy (83.3%) and higher sensitivity (82.4%) than palpation and computerized tomography, but the specificity of ultrasound elastography was lower (84.6%) than palpation and computerized tomography.ConclusionsUltrasound elastography is helpful for the diagnosis of lymph node metastases in patients with head and neck cancer. Due to its non-invasive character, it can be used safety in combination with other radiological techniques to support or improve their diagnostic performance.     

叶绿素染色在喉癌下咽癌颈淋巴结清扫术中的应用

目的 :探讨喉癌、下咽癌的颈淋巴结转移方式。方法 :对 5 0例喉癌、下咽癌患者于颈清扫术前 ,在喉及下咽粘膜下注射叶绿素使颈淋巴结系统染色 ,指导施行颈清扫术并收集淋巴结 ,进行连续切片观察。结果 :颈淋巴结被染成深绿色 ,与周围组织颜色对比明显 ,便于颈部手术和采集淋巴结 ;经病理检查证实 ,颈淋巴结总的转移率为 4 8% ,Ⅰ、Ⅴ区转移时均伴有其它区域的转移 ,Ⅱ、Ⅲ区转移率高于Ⅰ、Ⅳ、Ⅴ区 (P <0 .0 1) ;临床诊断颈淋巴结阴性 (cN0 )的患者淋巴结转移率为 2 3.5 % ,转移区域均在Ⅱ、Ⅲ区。结论 :临床诊断颈淋巴结阳性 (cN+ )喉癌、下咽癌患者的颈清扫手术 ,首先要保证清扫II、III区淋巴结 ,术中所见决定选择性颈清扫术式 ,对cN0 的下咽癌或声门上癌可行单侧或双侧颈深上、中淋巴结清扫术。叶绿素染色清晰 ,安全无毒 ,便于手术 ,可以在颈清扫术中常规应用     

Predictive ability of the CT to evaluate cervical lymph nodes in head and neck tumours

ObjectiveThe aim of this study was to determine the predictive value of computed tomography (CT) i.e., its sensitivity and specificity in detecting metastatic lymph nodes of head and neck tumours. We also studied the capacity of CT in correct nodal staging.Patients and methodsA CT was performed on 95 patients diagnosed with neoplastic disease of the pharynx and/or larynx. All patients subsequently underwent cervical lymph node dissections. In the imaging study, the following parameters were considered for suspected radiological nodal involvement: lymph node diameter greater than 10 mm, lesion margins poorly defined, capsule enhancement after contrast administration and lymph nodes that, despite their size, had signs of central necrosis.ResultsIn the dissections, 70.53% resulted N+ in the histological study. The sensitivity of CT was 82.09% and the specificity, 85.71%. The CT detected positivity in 55 of the 67 histologically pathological dissections, while the CT detected negativity in 24 of the 28 dissections histologically negative. The weighted kappa index value was 0.6408, indicating limited capacity for appropriate staging of the lymph nodes.ConclusionsWhile the ability of CT to detect metastatic lymph nodes in head and neck tumours is quite acceptable, it is less so for correctly staging them. It is therefore necessary to look for other imaging tests that provide greater accuracy to avoid unnecessary elective neck dissections and to reduce morbidity and mortality from them. We must now pay attention to new imaging techniques such as PET and PET/CT.     

Value of sonomorphologic criteria in the identification of regional metastases of squamous cell cancers of the ENT area

We compared the preoperative ultrasound findings with the histological results of 127 neck dissections for squamous cell carcinoma of the head and neck. We checked several sonomorphological criteria (size, shape, boundary, echo structure, arrangement, mobility) to assess their value in identification of metastatic disease. If all nodes found on ultrasound were classed as metastases, the specificity was 30%, because many lymph nodes showed nonspecific reaction only. Lymph nodes with a rupture of the capsule or central necrosis or being larger than 3 cm, proved to be metastatic in all cases. Round or oval nodes with a size of more than 2 cm were found to be metastatic with an accuracy of 89%. The almost certain (97%) identification of necks with no metastatic lymph nodes allows elective neck dissection to be avoided.     

Positron emission tomography using [<Superscript>18</Superscript>F]fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior?

The capability of modern imaging techniques such as CT, MRI, US and US-guided fine-needle aspiration cytology (USgFNAC) to detect small tumour deposits is limited. Therefore, the detection of occult metastases in the clinically negative neck remains a diagnostic problem. One of the novel options to refine staging of head and neck cancer is [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET). To evaluate the diagnostic value of FDG-PET in the detection of occult malignant lymph nodes, we compared the results of FDG-PET with other diagnostic techniques and the histopathological outcome of 15 neck dissection specimens from 15 head and neck cancer patients with a clinically negative neck. Three sides contained metastases of squamous cell carcinoma. FDG-PET enabled detection of metastases in two sides, which were also detected by MRI or USgFNAC. FDG-PET and CT missed metastases in one patient, which were detected by both MRI and USgFNAC. In studies with a detailed examination of lymph nodes of a neck dissection, a low sensitivity of FDG-PET for the detection of occult lymph node metastases is found. It is unlikely that FDG-PET is superior in the detection of occult lymph node metastases in head and neck cancer patients with a palpably negative neck. The histopathological method used seems to be the most important factor for the differences in sensitivity in reported FDG-PET studies. New approaches such as the use of monoclonal antibodies labelled with a positron emitter may improve the results of PET in these patients.     

Palpation and CT to evaluate the cervical adenopathies in head and neck tumours

Lymphatic metastasis is an important prognostic factor in patients with head and neck squamous cell carcinomas. Diagnostic evaluation and treatment of this adenopathies is very important. We can use physical examination, computered tomography (CT), magnetic resonance, ultrasound... but none of these give us a 100% security. This study evaluates the accuracy of physical examination and CT in detecting cervical lymph nodes. 120 neck dissections were performed after palpation and CT of 72 patients with head and neck carcinoma. Sensitivity of palpation was 51.7 and specificity 96.7. CTs sensitivity was 65 and specificity 86.7. Both, physical examination and palpation have a high number of mistakes evaluating cervical nodes. N0 necks are still a problem for Head and Neck Surgeons.     

Screening for lymph nodes in the neck with ultrasound

In a study of the value of ultrasound in staging patients with head and neck malignancies, we performed ultrasound of the neck. The results of this investigation were compared with palpation. A fine needle aspiration biopsy and/or histologic examination was carried out on lymph nodes which were found. One hundred and six patients were included in this study. In 44 of the patients no lymph nodes could be detected, either on palpation or by ultrasound examination. In the other 62 patients all palpable lymph nodes were also demonstrated by ultrasound. However, in 20 patients with negative palpatory findings, ultrasound revealed lymph nodes: 11 metastases and 9 benign nodes. In 40 patients an ultrasound guided fine needle aspiration biopsy (UGFNAB) was performed. In 85% of these patients a cytological diagnosis could be made. From these results we conclude that ultrasound and UGFNAB are of considerable value in staging head and neck malignancies.