Kuznetsova A.S., Parshin V.S., Bespalov P.D., Vdovina S.N., Sevryukov F.E. Comparison of the metastasis ultrasound image features between the laryngeal cancer and papillary thyroid cancer. Head and neck. Russian Journal. 2021;9(4):14–22 (In Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
Laryngeal cancer diagnostics is still a relevant problem in modern oncology since laryngeal malignancies represent one of the most common types of head and neck cancer. Laryngeal cancer accounts for 2–5% of all malignancies, and for 50–60% of all malignant head and neck tumors worldwide. Timely receipt of information about the location and size of the primary tumor as well as the tumor extent enables a specialist to choose an optimal surgical volume, to develop innovative strategies of combination therapy and to improve the treatment efficacy considerably. Although the symptoms of laryngeal cancer appear early in the disease course (sore throat, hoarseness, etc.), most of them are not cancer-specific, so in some cases, they may be misdiagnosed, which leads to inaccurate treatment and delayed cancer diagnosis. Head and neck cancers have a great potential for metastasizing to the regional zones of lymph outflow, while the lymph node status not only affects the treatment choice but is also an important prognostic factor. Therefore, ultrasound examination of regional lymph nodes is mandatory for all the patients to determine the clinical stage.
Objective. The purpose of this study was to evaluate the feasibility of sonography in detecting metastases of laryngeal cancer and to compare ultrasound imaging features of cervical lymph node metastases in laryngeal cancer with those in papillary thyroid cancer (PTC).
Material and methods. The study included 101 patients with histologically verified laryngeal cancer. Cervical lymph node metastases were morphologically confirmed in 20 patients. For detecting metastases in lymph nodes, 7 levels of the neck were examined according to the modern classification of lymph node levels proposed by the American Joint Committee on Cancer and the American Academy of Otolaryngology – Head and Neck Surgery. B-mode and Doppler ultrasound imaging was performed on the EPIQ 5 ultrasound system (PHILIPS, The Netherlands) using the high frequency (7–13.5 MHz) linear array transducer. Moreover, US-guided fine needle aspiration biopsy (FNAB) of cervical lymph nodes was performed to confirm the presence of metastases. Statistical data processing was conducted using fourfold contingency tables. A receiver operating characteristic (ROC) curve was constructed to evaluate diagnostic accuracy. Cervical lymph node metastases from laryngeal cancer were compared with those from papillary thyroid cancer (167 patients).
Results. Patients with primary diagnosed laryngeal cancer accounted for 61% and those with recurrent laryngeal cancer for 39% of the participants. Cervical lymph node metastases occurred most frequently in patients with T3 stage cancer. Nodal metastases were found in 20 cases, mainly at level II. Cervical lymph node metastases
had the following imaging features: oval shape (65%) or irregular shape (35%), poor differentiation between layers (100%), decreased echogenicity (100%), heterogeneous echo-structure (45%). The size of lymph node metastases ranged from 1.0 cm to 6.0 cm, the median size was 2.26±1.42 cm. Ultrasound had a high diagnostic value in detecting laryngeal cancer metastasis and showed sensitivity of 95%, specificity of 64%, accuracy of 73%, positive predictive value of 50% and negative predictive value of 97%.
Conclusions. Laryngeal cancer metastases were most frequently found in level II cervical lymph nodes (55%). The incidence of metastases increased with increasing primary tumor extent. Laryngeal cancer metastases had the following characteristics: oval shape, decreased echogenicity, no differentiation between cortical and medullar layers. The median size of a metastasis was 2.26±1.42 cm. There were statistically significant differences in the size and echo-structure between nodal metastases of laryngeal cancer and those of papillary thyroid cancer.
Key words: laryngeal cancer, papillary thyroid cancer, metastases, cervical lymph nodes, ultrasound, FNAB, level I-VII cervical lymph nodes
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.