Residual or relapse cervical lymph node metastasis after radiotherapy and/or chemotherapy for nasopharyngeal carcinoma:MRI,color Doppler ultrasonography versus physical palpation

Objective To study the value of magnetic resonance imaging(MRI) and color Doppler ultrasonography (CDU) in the diagnosis of occult residual or relapse cervical lymph node metastasis after radiotherapy and/or chemotherapy for nasopharyngeal carcinoma.Methods Fifty-six patients(60 sides) were studied doubleblindedly by MRI,CDU and physical palpation prior to cervical lymphadenctomy,and the results were contrasted with histopathologic findings.Results According to histologic examination of the dissected specimens,in 43 of 60 sides there were occult residual or relapse cervical lymph node metastasis,30 of 43 sides with occult residual or relapse cervical lymph node metastasis were diagnosed by manual palpation(sensitivity 69.77%;specificity 64.70%;accuracy 68.33%).However,residual or relapse cervical lymph node metastasis in 40 sides were revealed by MRI (sensitivity 93.02%;specificity 88.89%;accuracy 91.66%) and MRI discovered 76.9%(10/13) of occult residual or relapse cervical lymph node metastasis which were not found in physical palpation.Residual or relapse cervical lymph node metastasis were diagnosed accurately in 39 sides by CDU(sensitivity 92.85%;specificity 76.47%;accuracy 86.67%),and 69.23%(9/13) of the occult residual or relapse cervical lymph node metastasis which were not found in physical palpation were found by CDU.Conclusion MRI,CDU examinations are superior to physical palpation in ascertaining occult residual or relapse cervical lymph node metastasis after radiotherapy and/or chemotherapy for nasopharyngeal carcinoma.