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Evaluation of cervical lymph nodes (duplex scan and color Doppler)
S72
Ultrasound in Medicine & Biology
respectively). A solid mass with small cysts should suggest the possibility of Warthin’s tumor. Of 171 patients with parotid masses (35 malignant and 136 benign lesions) that underwent either US-guided fine needle aspiration (UGFNA) (n = 107) or US-guided core needle biopsy (UGCNB) (n = 64), UGCNB had a significantly higher sensitivity (94.1%) than that of UGFNA (55.6%, p < 0.05) in differentiating benign from malignancy. The specificity and accuracy of UGCNB were higher than that of UGFNA (100% and 98.4% vs. 93.3% and 86.9%, respectively). UGCNB provided more specific diagnosis than UGFNA (100% vs. 93.3%, p < 0.05). All patients with lymphomas were correctly diagnosed by UGCNB (100%), while none were correctly identified by UGFNA. It is concluded that UGCNB rather than UGFNA should be performed when a definite diagnosis of a parotid solid mass is expected clinically. An 18 G needle is sufficient to establish a confident diagnosis by core biopsy. References: 1. Wan YL, et al. Sonographic analysis of salivary gland masses. J Med Ultrasound 1003;11:1-6. 2. Wan YL, et al. Ultrasound-guided core needle biopsy of parotid gland masses. Am J Neuroradiol 2004; 25:1608-12. 3. Schmidt RL, et al. A systematic review and meta-analysis of the diagnostic accuracy of ultrasound-guided core needle biopsy for salivary gland lesions. Am J Clin Pathol 2011;136:516-26. 4. Huang YC, Wan YL*. Comparison of ultrasonographically guided fine needle aspiration and core needle biopsy in the diagnosis of parotid masses. J Clin Ultrasound 2012;40:189-94.
Evaluation of cervical lymph nodes (duplex scan and color Doppler) Maria Cristina Chammas Director of Ultrasound Division, School of Medicine, University of S~ ao Paulo, Brazil Characterization of lymph nodes is an important clinical issue, as lymph node metastasis is a critical prognostic factor in cancer patients. Yet physical examination of the neck fails to detect 27 38% of lymph node metastases. Cervical US is the method of choice for the identification of LN metastases. US can provide valuable information in the preoperative work-up of head and neck cancers, because it can differentiate lymph nodes from other masses. Besides, US can even be combined with fineneedle aspiration biopsy (FNAB), thus allowing an evaluation of both the primary tumor and possible cervical metastases in a single examination. Regarding to US important diagnostic features such as size, shape, margins, boundaries, echotexture, and abnormal vascularization, differentiation between benign and malignant lymph nodes will be showed in this presentation. US B-mode can study and describe morphology (globular/elongated); echogenicity (habitual/hypoechogenic/hyperechogenic); echotexture (homogenous/heterogeneous); contours (regular/ irregular, defined/poorly defined/ partially defined); hylum (absent, eccentric, thin/thickened, normal); necrosis; calcifications. The ultrasonographic features of cervical metastatic carcinoma include a round shape, loss of the nodal hilum, microcalcifications, necrosis, signs of invasion, hypoechogenicity, irregular contours, heterogeneous texture. The vascularization patterns, studied by a color Doppler US, will be presented and are classified as: (1) normal: the blood flow was hilar or central hilar vascularity, without peripheral vessels or absent (suggestive of benignity)
Volume 45, Number S1, 2019 (2) altered: vessels were mapped in the subcapsular region, with a radial distribution, disorganized and tortuous/ irregular vessels, sprinkled, or with a mixed pattern.The malignant lymph nodes show IR higher than the benign (>0,77). The presence of changes in any of these ultrasonographic features during the follow-up of cervical LNs requires an effective investigation with FNA ultrasound-guided. Ultrasonographic assessment of neck lymphadenopathy can be difficult because sometimes the same pattern is seen both in inflammatory (specific or non-specifc) and neoplastic diseases (lymphoproliferative or metastatic).US remains the most important imaging modality in the evaluation of cervical LNs and thyroid cancer, and should be used preoperatively as a routine examination. Then, radiologists should be familiar with the prognostic implications of LN metastases, the limitations of each imaging tool and their role in the differentiation of lymphadenopathy.
Vascular curiosities in the head and neck region Martin Necas Specialist Sonographer, Waikato Hospital, Department of Radiology Ultrasound, Hamilton, New Zealand The head and neck represents the most complex anatomical region with contributions from virtually all body systems. For this reason, the pathology of the head and neck tends to be correspondingly complex and wide-ranging. In this presentation, we will review numerous vascular pathologies that can affect the head and neck including microvascular disease of the: carotid, vertebral, subclavian and jugular veins, graft and aneurysm and well as vascular anomalies, vascular tumors and malformations. In this presentation, we will look at a wide variety of interesting and unusual cases to showcase how diagnostic ultrasound can assist with clinical problem-solving.
HPV in the head and neck region Jo McCann Senior Sonographer, Hamilton, New Zealand The incidence of HPV-positive Squamous Cell Carcinoma of the oropharynx has rapidly increased over the past ten years. The majority of these patients present with a painless neck mass. Radiology-based ultrasound has traditionally been used as first line imaging to characterise these masses and to guide a fine needle aspirate (FNA)biopsy. Common sites for primary lesions are the tonsils and the base of the tongue. These sites have not traditionally been examined during a radiology-based ultrasound. This talk will discuss the transcervical ultrasound approach to scanning the tongue and the tonsils.
SESSION 14H: PROFESSIONAL ISSUES FOR ALL ULTRASOUND PROVIDERS Ultrasound education in Bangladesh Kanu Bala University of Science and Technology [USTC], Dhaka, Bangladesh Bangladesh is the eighth biggest country of the world with a population of 165 millions, about 2.5% of the world population. In 1980, 2D realtime ultrasound was introduced as heart imaging. In 1982, the only static ultrasound machine was established for routine imaging of abdomino-pelvicsoft tissue imaging and immediately becomes very popular.
Ultrasound in Medicine & Biology
respectively). A solid mass with small cysts should suggest the possibility of Warthin’s tumor. Of 171 patients with parotid masses (35 malignant and 136 benign lesions) that underwent either US-guided fine needle aspiration (UGFNA) (n = 107) or US-guided core needle biopsy (UGCNB) (n = 64), UGCNB had a significantly higher sensitivity (94.1%) than that of UGFNA (55.6%, p < 0.05) in differentiating benign from malignancy. The specificity and accuracy of UGCNB were higher than that of UGFNA (100% and 98.4% vs. 93.3% and 86.9%, respectively). UGCNB provided more specific diagnosis than UGFNA (100% vs. 93.3%, p < 0.05). All patients with lymphomas were correctly diagnosed by UGCNB (100%), while none were correctly identified by UGFNA. It is concluded that UGCNB rather than UGFNA should be performed when a definite diagnosis of a parotid solid mass is expected clinically. An 18 G needle is sufficient to establish a confident diagnosis by core biopsy. References: 1. Wan YL, et al. Sonographic analysis of salivary gland masses. J Med Ultrasound 1003;11:1-6. 2. Wan YL, et al. Ultrasound-guided core needle biopsy of parotid gland masses. Am J Neuroradiol 2004; 25:1608-12. 3. Schmidt RL, et al. A systematic review and meta-analysis of the diagnostic accuracy of ultrasound-guided core needle biopsy for salivary gland lesions. Am J Clin Pathol 2011;136:516-26. 4. Huang YC, Wan YL*. Comparison of ultrasonographically guided fine needle aspiration and core needle biopsy in the diagnosis of parotid masses. J Clin Ultrasound 2012;40:189-94.
Evaluation of cervical lymph nodes (duplex scan and color Doppler) Maria Cristina Chammas Director of Ultrasound Division, School of Medicine, University of S~ ao Paulo, Brazil Characterization of lymph nodes is an important clinical issue, as lymph node metastasis is a critical prognostic factor in cancer patients. Yet physical examination of the neck fails to detect 27 38% of lymph node metastases. Cervical US is the method of choice for the identification of LN metastases. US can provide valuable information in the preoperative work-up of head and neck cancers, because it can differentiate lymph nodes from other masses. Besides, US can even be combined with fineneedle aspiration biopsy (FNAB), thus allowing an evaluation of both the primary tumor and possible cervical metastases in a single examination. Regarding to US important diagnostic features such as size, shape, margins, boundaries, echotexture, and abnormal vascularization, differentiation between benign and malignant lymph nodes will be showed in this presentation. US B-mode can study and describe morphology (globular/elongated); echogenicity (habitual/hypoechogenic/hyperechogenic); echotexture (homogenous/heterogeneous); contours (regular/ irregular, defined/poorly defined/ partially defined); hylum (absent, eccentric, thin/thickened, normal); necrosis; calcifications. The ultrasonographic features of cervical metastatic carcinoma include a round shape, loss of the nodal hilum, microcalcifications, necrosis, signs of invasion, hypoechogenicity, irregular contours, heterogeneous texture. The vascularization patterns, studied by a color Doppler US, will be presented and are classified as: (1) normal: the blood flow was hilar or central hilar vascularity, without peripheral vessels or absent (suggestive of benignity)
Volume 45, Number S1, 2019 (2) altered: vessels were mapped in the subcapsular region, with a radial distribution, disorganized and tortuous/ irregular vessels, sprinkled, or with a mixed pattern.The malignant lymph nodes show IR higher than the benign (>0,77). The presence of changes in any of these ultrasonographic features during the follow-up of cervical LNs requires an effective investigation with FNA ultrasound-guided. Ultrasonographic assessment of neck lymphadenopathy can be difficult because sometimes the same pattern is seen both in inflammatory (specific or non-specifc) and neoplastic diseases (lymphoproliferative or metastatic).US remains the most important imaging modality in the evaluation of cervical LNs and thyroid cancer, and should be used preoperatively as a routine examination. Then, radiologists should be familiar with the prognostic implications of LN metastases, the limitations of each imaging tool and their role in the differentiation of lymphadenopathy.
Vascular curiosities in the head and neck region Martin Necas Specialist Sonographer, Waikato Hospital, Department of Radiology Ultrasound, Hamilton, New Zealand The head and neck represents the most complex anatomical region with contributions from virtually all body systems. For this reason, the pathology of the head and neck tends to be correspondingly complex and wide-ranging. In this presentation, we will review numerous vascular pathologies that can affect the head and neck including microvascular disease of the: carotid, vertebral, subclavian and jugular veins, graft and aneurysm and well as vascular anomalies, vascular tumors and malformations. In this presentation, we will look at a wide variety of interesting and unusual cases to showcase how diagnostic ultrasound can assist with clinical problem-solving.
HPV in the head and neck region Jo McCann Senior Sonographer, Hamilton, New Zealand The incidence of HPV-positive Squamous Cell Carcinoma of the oropharynx has rapidly increased over the past ten years. The majority of these patients present with a painless neck mass. Radiology-based ultrasound has traditionally been used as first line imaging to characterise these masses and to guide a fine needle aspirate (FNA)biopsy. Common sites for primary lesions are the tonsils and the base of the tongue. These sites have not traditionally been examined during a radiology-based ultrasound. This talk will discuss the transcervical ultrasound approach to scanning the tongue and the tonsils.
SESSION 14H: PROFESSIONAL ISSUES FOR ALL ULTRASOUND PROVIDERS Ultrasound education in Bangladesh Kanu Bala University of Science and Technology [USTC], Dhaka, Bangladesh Bangladesh is the eighth biggest country of the world with a population of 165 millions, about 2.5% of the world population. In 1980, 2D realtime ultrasound was introduced as heart imaging. In 1982, the only static ultrasound machine was established for routine imaging of abdomino-pelvicsoft tissue imaging and immediately becomes very popular.