Contribution of Doppler sonography blood flow information to the diagnosisof 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 adenopa thy by use of size criteria is effective, the sensitivity and specificity f all short of that required to make adequate judgments regarding neck dissec tion. Therefore, we tested whether the combined use of size criteria and Do ppler sonographic findings would improve the predictive ability for metasta tic cervical nodes. METHODS: We analyzed 338 histologically proved cervical lymph nodes (108 me tastatic and 230 nonmetastatic) in 73 patients with head and neck cancer. T he sonographic topography of the nodes was compared with dissected specimen s, 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 absenc e 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 incre ased the diagnostic accuracy of sonography at all levels in the neck. Accor dingly, the best cut-off values were improved to 6, 7, and 5 mm for nodes a t levels I, II, and III+IV, respectively. In addition, the combined criteri a yielded high sensitivities (greater than or equal to 89%) and specificiti es (greater than or equal to 94%). CONCLUSION: Hilar blood flow information obtained by Doppler sonography sig nificantly improves diagnostic accuracy for the detection of nodes metastat ic from head and neck squamous cell carcinoma.