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.