Comparison of palpation and ultrasonography in evaluation of cervical lymph node metastases in patients presenting with head and neck cancers at Mulago Hospital.
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BACKGROUND: Head and neck cancers include cancers from the nose, ears, paranasal sinuses, oropharyx, nasopharynx, hypo pharynx, laryx and thyroid, parotid and the salivary glands. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate by 50%. Therefore, evaluation of cervical lymphadenopathy is important for patients with head and neck cancers as it helps the assessment of patient prognosis and the selection of treatment method. OBJECTIVE: Compare palpation and ultrasound (USG) with respect to their ability to detect presence of metastatic cervical lymph nodes and their characteristics in patients with head and neck cancers. METHODS: This case series was conducted in Mulago National Referral Hospital. Participant enrolled in this study were patients with a confirmed histological diagnosis of a primary head and neck cancer and had consented to the study. From February 2008 to August 2008, palpation and USG were performed on the patients who satisfied the selection criteria and the results obtained from both methods of examination were compared. RESULTS: Twenty five patients were recruited in the study and of these, five had surgery. The mean age distribution was 54.24 (SD=14.584). Most of the patients (84%) were male. The average neck size of the patients was 35.782cm (std. dev=4.56, N=11). Most of the patients recruited in the study had carcinoma of the larynx, (48%) followed by carcinoma of the hypopharynx (12%) and oropharynx (12%). Palpation was able to detect 7 lymph nodes (from patients) less than 1cm, 22 lymph nodes 1-2.9cm, 0 lymph nodes 3-6cm and 3 lymph nodes more than 6cm. 18 lymph nodes were found to be firm, 14 were found to be hard and no lymph node was found to be cystic. On palpation, most of the patients (11/25) were no followed by N1 (7/25), N3 (3/25), N2a and N2c 2/225 and no patient was staged N2b. In terms of echogenicity, 88 lymph nodes had an absent or accentric nidus while 12 lymph nodes had a central echogenic nidus (hilus). In terms of nodal staging bu USG, Majority of the patients (72%) were staged N0, followed by N1 (16%) and N2a (12%), no patients were staged N2b, N2c and N3. On the 5 patients in the study who were able to undergo surgery, palpation was able to detect a total of 2 lymph nodes with probable cancer while USG detected 10/33 lymph nodes. Histology confirmed that 10 lymph nodes out 35 lymph nodes examined in the biopsy specimens had cancer in them. CONCLUSION: 1. The significant characteristic of metastatic cervical lymph nodes detected by palpation was lymph node size, consistency, nodal level and presence of ulceration. 2. The significant characteristics of metastatic cervical lymph node detected by ultrasonography were lymph node size, echogenicity, nodal levels, and presence of intranodal calcification or necrosis. 3. In our study ultrasonography was found to be of better diagnostic value in detecting metastatic cervical lymph nodes as compared to palpation.