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Comparison of Sonography and CT for Differentiating Benign from Malignant Cervical Lymph Nodes in Patients with Squamous Cell Carcinoma of the Head and Neck

Misa Sumi1, Masafumi Ohki2 and Takashi Nakamura1

1 Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan.
2 Department of General Education, School of Health Sciences, Kyushu University, Fukuoka 812-0054, Japan.



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  		Fig. 1A. —70-year-old man with nonmetastatic (reactive) node from squamous cell carcinoma of buccal mucosa. CT scan obtained after injection of contrast material shows reactive node (arrow) that has failed to enhance.

 


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  		Fig. 1B. —70-year-old man with nonmetastatic (reactive) node from squamous cell carcinoma of buccal mucosa. Gray-scale sonogram shows same reactive node (arrows) as shown in A. Note associated hilar echogenicity.

 


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  		Fig. 1C. —70-year-old man with nonmetastatic (reactive) node from squamous cell carcinoma of buccal mucosa. Power Doppler sonogram of reactive node shows blood flow signal overlapping hilar echogenicity.

 


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  		Fig. 2A. —63-year-old man with squamous cell carcinoma of tongue. CT scan obtained after injection of contrast material shows metastatic node (arrow). Note rim enhancement.

 


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  		Fig. 2B. —63-year-old man with squamous cell carcinoma of tongue. Gray-scale sonogram shows same node (arrows) as shown in A. Note absence of normal hilar echogenicity.

 


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  		Fig. 2C. —63-year-old man with squamous cell carcinoma of tongue. Power Doppler sonogram shows metastatic node. Note peripheral blood flow signal.

 


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  		Fig. 3A. —66-year-old man with squamous cell carcinoma of oral floor. CT scan obtained after injection of contrast material shows metastatic node (arrow), exhibiting homogeneous enhancement.

 


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  		Fig. 3B. —66-year-old man with squamous cell carcinoma of oral floor. Gray-scale sonogram shows same node (arrows) as seen in A. Note irregularly distributed echogenicity.

 


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  		Fig. 3C. —63-year-old man with squamous cell carcinoma of oral floor. Power Doppler sonogram shows abnormal parenchymal blood flow signals.

 


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  		Fig. 4. —Graph shows receiver operating characteristic curve analysis for CT (dashed line), gray-scale sonography (dotted line), and gray-scale plus power Doppler sonography (solid line) by overall impression. Note that sonography performs better than CT.

 


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  		Fig. 5. —Graph shows receiver operating characteristic curve analysis for sonography by overall impression (gray-scale = dashed line, gray-scale and power Doppler sonography = upper solid line), internal architecture (gray-scale = lower dotted line, gray-scale and power Doppler sonography = upper dotted line), and short-axis length (lower solid line). Note higher performance by internal architectural assessment compared with that by short-axis diameter assessment.

 


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  		Fig. 6. —Graph shows receiver operating characteristic curve analysis for CT by overall impression (upper solid line), internal architecture (dotted line), long-axis diameter (dashed line), and short-axis diameter (lower solid line). Note that performance by internal architectural assessment does not exceed that by short-axis diameter assessment and that short-axis diameter assessment performs better than long-axis diameter assessment does.

 

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