Abstracts
2) To discuss the current literature and best practice recommendations for
imaging evaluation (US) and FNA of cervical lymph nodes indications.
3) To present the best imaging criteria to distinguish benign and
malignant lymph nodes.
Abstract
The distinction between malignant and non-malignant lymph nodes is a
challenge in clinical practice. This is because a large number of
patients present with enlarged lymph nodes, whose distinction is
unreliable on physical examination. Characterization of lymph nodes
is an important clinical issue, because lymph node metastasis is a
critical factor in predicting prognosis.
US can provide valuable information in the preoperative work-up of
head and neck cancers, since it is able to differentiate lymph nodes
from other masses, and in some instances helps to indicate whether
a given node is more likely to be normal or abnormal.
The best and more relevant signals of malignancy are: the abnormal hylo
(absent, eccentric, or thin), size, heterogeneous echotexture (presence
of necrosis and calcifications), hypoechoic echogenicity, altered
vascularization on color Doppler (when vessels were mapped in the
subcapsular region, with a radial distribution, tortuous, sprinkled, or
mixed pattern); on spectral Doppler, the RI higher or equal to 0.77.
T21-15-IN09
Ultrasonography and Ultrasound-Guided
Intervention of Salivary Glands
Yung-Liang Wan, M.D.
Department of Medical Imaging and Intervention, Chang Gung
Memorial Hospital at Linkou, College of Medicine, Chang Gung
University, Taoyuan, Taiwan
An accurate diagnoses of salivary gland masse is clinically critical for
optimal patients’ management. A patient with sialadenitis, benign neoplasm
or lymphoid hyperplasia may be treated conservatively. Patients with lym-
phoma may undergo chemotherapy or radiation therapy after systemic stag-
ing, while those with primary malignancy may be treated by surgery.
Ultrasonography (US) has become an optimal diagnostic tool due to
its non-invasiveness, non-irradiation, multi-planar capability and high
portability.
US-guided fine needle aspiration (USFNA) and US-guided core nee-
dle biopsy (USCNB) have also been used to increase the accuracy in
diagnosing salivary gland masses.
On sonograms, significant difference can be found between the
benign and malignant lesions of parotid gland with respect to the shape.
The benign neoplasms and lymphoid hyperplasia are more likely to have
homogeneous texture, well-defined margin and round or oval shape;
while the malignancies and inflammatory lesions tend to be heteroge-
neous with indistinct margin and irregular shape.
USFNA is a well-accepted and widely used technique for the pre-
liminary diagnosis of salivary gland masses. It is safe, fast, and
well-tolerated. In the literature, on average, it has a high specificity
(98%) but lower sensitivity (80%) in differentiating benign from ma-
lignant salivary gland masses. According to our reports, USFNA has
a sensitivity of 71%, a specificity of 98%, and an accuracy of 94%
in differentiating benign from malignant parotid masses. The corre-
sponding figures for the USCNB are 98%, 100% and 98%, respec-
tively. USCNB has positive and negative predictive values of 100%
and 96%, respectively, in diagnosing malignancies.
Thus, a positive diagnosis by FNAC is reliable, but the false-negative rate
associated with FNAC may be unacceptable. Accurate diagnoses and sub-
typing of lymphoma cannot be reliably made on the basis of cytology.
A meta-analysis report on five studies with 277 cases published be-
tween 2002 and 2009 showed that the sensitivity of USCNB is 0.92
(95% CI, 0.77-0.98) and the specificity is 1.00 (95% CI, 0.76-1.00). It
is concluded that USCNB has a high accuracy and a low (1.2%) inade-
quacy rate for diagnosing salivary gland masses.
S243
In this presentation, the techniques to avoid complications of USCNB
will also be discussed.
T21-15-IN10
Cancer Detection in Human Lymph Nodes Using
Quantitative Ultrasound
Jonathan Mamou
F. L. Lizzi Center for Biomedical Engineering, Riverside Research, New
York, NY, USA
Quantitative ultrasound (QUS) approaches using high-frequency
ultrasound (HFU, .20 MHz) permit characterizing tissue micro-
structure with fine spatial resolution. In a recent study, 3D imaging
and QUS methods were applied to detect metastatic regions of lymph
nodes freshly-excised from cancer patients. Accurate determination
of lymph-node status is of paramount importance for proper staging
and patient management. These QUS methods could reduce the rate
of false-negative determinations by guiding the pathologist towards
suspicious regions in lymph nodes. 3D radio-frequency data were ac-
quired from more than 400 freshly excised lymph nodes using a
spherically focused transducer with a 26-MHz center frequency.
QUS analyses based on the backscatter coefficient and envelope sta-
tistics were applied to the 3D RF data to obtain QUS estimates
throughout each individual lymph node. Classification results sug-
gest that these QUS methods may provide a clinically-important
means of identifying small metastatic foci that might not be detected
using standard pathology procedures.
T21-15-IN11
Scrotal Ultrasound for Assessment of Pain, Masses
and Fertility
Stephen Bird
Benson Radiology, Bird Ultrasound
Sonography remains the most effective imaging modality for assess-
ment of scrotal pathology. This paper will explore the applications of
ultrasound in a variety of clinical settings. Acute pain, chronic pain,
palpable lumps, scrotal swelling, trauma, cryptorchidism and infer-
tility assessment will be explored. A variety of potential pitfalls as
well as some interesting normal variants and benign intra-testicular
masses are considered. A protocol for extending sonographic assess-
ment of varicoceles beyond the scrotum, particularly in the setting
of infertility is presented. Many recent clinical cases are used to
demonstrate the sonographic appearances of a comprehensive range
of scrotal conditions.
T21-15-IN12
Ultrasound in the Assessment of
Temporomandibular Joint Disorder
Li-Jen Liao
Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei,
Taiwan
Temporomandibular disorders (TMD) affect nearly 10-70% of popu-
lation. It refer to changes in the temporomandibular joint (TMJ) articular
capsule and muscles of mastication. In the past, the diagnosis of such a
condition was limited to physical examination and plain radiological ex-
amination by means of radiography of the joint with the patient at rest
and after opening the mouth, with lateral and panoramic views of the
mandible. Up to date, ultrasound (US) is routine used to check the
neck pathology. US can be also used to check the TMJ. The author
would like to introduce the application of high resolution US in the
TMJ assessment. The diagnostic performance of US to determinate
TMJ disorder will be also reported.