Cervical lymph node metastases in patients with squamous cell carcinoma of the oropharynx:Ultrasound,MRI,US/MRI versus physical palpation

PURPOSE:This study was designed to evaluate the accuracy and to identify the clinical value of ultrasound,magnetic resonance imaging(MRI) and physical palpation in the preoperative detection of cervical lymph node metastases in patients with squamous cell carcinoma of the oropharynx per level(ⅠthroughⅤ).METHODS:Twenty patients(100 levels)were studied double-blindedly by MRI,ultrasonography and physical palpation prior to cervical lymphadenectomy,and palpation,US,MRI and US/MRI were compared for specificity,sensitivity and accuracy with Chi-square test or Fisher's exact test by SPSS13.0 software package.Pathologic diagnosis of the surgical specimens served as the gold standard.RESULTS:According to histologic examination of the dissected specimens,in 16 of 100 levels there were cervical lymph node metastases,7 of the 16 levels with metastatic nodes were diagnosed by manual palpation(sensitivity,43.8% ;specificity,96.4% ;accuracy,88.0%).Cervical lymph node metastases in 10 levels were revealed by ultrasonography(sensitivity,60.0%;specificity,97.6%;accuracy,92.0%),ultrasound discovered 33.3% of the occult metastatic nodes in this series.Lymph node metastases were diagnosed accurately in 13 levels by MRI(sensitivity,81.3%;specificity,96.4%;accuracy,94.0%),and 66.7% of the occult metastatic nodes were found by MRI.Cervical lymph node metastases in 13 levels were revealed by US/MRI(sensitivity,81.3%;specificity,95.2%;accuracy,93.0%).CONCLUSIONS:MRI,ultrasound examinations are superior to physical palpation in ascertaining cervical lymph node metastasis in patients with squamous cell carcinoma of the oropharynx;there is no significant difference in sensitivity or specificity among US/MRI,US and MRI,but US and MRI are complementary to each other.