The value of ultrasound examination in preoperative neck assessment and inearly diagnosis of nodal recurrences in the follow-up of patients operatedfor laryngeal cancer

The purpose of this study was to prove the superiority of ultrasound (US) e xamination of the neck in comparison to palpation, to reveal unpalpable nod es (pN0) before surgery, and to allow for the early detection of nodal recu rrences in patients with laryngeal cancers. In all, 1,120 patients with lar yngeal cancers were operated on between 1990 and 1997. All underwent palpat ion and neck US before surgery. In the pN0 group US revealed enlarged lymph nodes in 261/505 cases, of which 63 (24.14%) were confirmed as metastatic by histology. All 1,120 patients underwent regular postoperative US follow- up. Nearly 5,000 US examinations were performed; 136 patients who developed nodal recurrences had surgical salvage procedures. In this group 61 patien ts had small, nonpalpable lesions, and 46 patients discrete and slight chan ges in scarred necks. In this latter group of 117 patients with nonpalpable lesions, 105 cases were histologically confirmed as metastatic. In postope rative check-ups, metastases were suspected in sonographically detected sub clinical nodes, but the US scans obtained were difficult to interpret. In t hese cases, because of the dynamics of lesion changes, US was repeated two to three times at 10- to 14-day intervals. This reappraisal enabled us to e xclude malignancy in regressing nodes, as well as to obtain the stable pict ure of scar, and support a diagnosis while the lesion grew larger or a cent ral area of low attenuation or hypoechogenic echos appeared in the nodal ca psule. Successful radical reoperation for tumor was done on110 patients; 78 patients underwent successful salvage surgery after an early US diagnosis. The sonographic-surgical correlation was nearly 95% and the sonographic-hi stological correlation was 90%. The follow-up period was 1-49 months. In al l preoperative assessments US was found to be a valuable tool in the stagin g of laryngeal cancer and planning the extent of surgery. Close follow-up w ith US after radiotherapy and initial operation was essential for the early detection of tumor recurrences, making surgical salvage still feasible.