METASTATIC CARCINOMA IN THE NECK - A CLINICAL, COMPUTERIZED-TOMOGRAPHY SCAN AND ULTRASOUND STUDY

Metastatic cervical lymph node involvement is a major determinant of t reatment planning and prognosis of upper aerodigestive tract tumours. If the metastatic tumour invades the carotid artery wall then complete tumour excision is not possible unless carotid artery ligation or rep lacement is planned. A prospective study was performed to assess the r ole of palpation, computerized tomography (CT) and B-mode ultrasound s canning in the detection of metastatic cervical lymph node involvement in patients with upper aerodigestive tract tumours. In particular, de tection of carotid artery wall invasion by tumour was examined. Thirty -two neck dissection specimens were available for histopathological co nfirmation of findings. Palpation under general anaesthesia was 87.5% sensitive and 87.5% specific in the detection of involved nodes. If a positive finding was defined as detection of a node greater than 15 mm in largest diameter, CT scanning was 78.6% sensitive and 93.8% specif ic, and the sensitivity of ultrasound was 81.3% and specificity was 84 .6%. Ultrasound scanning was sensitive in excluding carotid artery wal l invasion, identifying five out of five cases with one false positive and no false negative reports. The combination of palpation under gen eral anaesthesia and B-mode ultrasound imaging provides a sensitive me ans of detecting the presence of metastatic cervical lymphadenopathy a nd invasion of the carotid artery wall.