Ultrasound usage in the head and neck surgeon's office

To review the essential developments in neck sonography published in the past 12 months and to elucidate their influence on the indications and diagnostic accuracy of office-based ultrasonography.

In the screening of the neck in patients with squamous cell carcinoma, sonographic and duplex sonographic characteristics have been described to identify lymph node metastases, that is, size, shape, echogenicity, homogeneity, absence of hilar sign and hilar vessel, surface irregularity, necrotic areas, evidence of extracapsular spread, peripheral perfusion pattern, focal vascularization defects, and high pulsatility index. The combination of conventional ultrasound, duplex sonography, and ultrasound-guided fine-needle aspiration biopsies (USgFNAB) achieves an overall accuracy of nearly 100%. Ultrasound has been found to be most accurate in the diagnosis and differential diagnosis of thyroid and parathyroid disorders, the localization of parathyroid adenomas and the differential diagnosis of thyroid gland disorder. Sonographic characteristics, however, are mostly unspecific. Sonography provides the chance to obtain cytologic material under direct view by USgFNAB.

Office-based ultrasonography is a simple and rewarding technique that is enhanced by the experience of the investigator. The neck surgeon who is caring for the patient might use this information for diagnostic and therapeutic management. Due to high accuracy, noninvasiveness, and lack of radiation exposure, ultrasonography is required in the diagnosis and differential diagnosis of any pathologic masses in the entire neck and prior to any surgical procedure. Future developments, that is, elastography, might lead to further improvement in the diagnostic accuracy to differentiate benign and malignant masses.