Publication:

Evaluation of metastatic cervical lymph nodes by clinical examination, ultrasonography and diffusion weighted MRI in patient of head and neck squamous cell carcinoma: a prospective study

Background Accurate evaluation of cervical lymph node metastasis is essential for staging and management of head and neck cancers. Clinical examination has limited sensitivity in detecting occult disease. Ultrasonography improves assessment through morphological and vascular evaluation, while diffusion-weighted magnetic resonance imaging provides functional information based on tissue cellularity. This study aimed to compare the diagnostic performance of these three modalities.

Methods This prospective observational study was conducted on 50 patients with histopathologically confirmed head and neck carcinoma over a period of 18 months. All patients underwent systematic evaluation using clinical examination, ultrasonography, and diffusion-weighted MRI for assessment of cervical lymph nodes. The diagnostic sensitivity of each modality was determined, and apparent diffusion coefficient (ADC) values were quantitatively analyzed.

Results In this study, the mean age was 54.18±12.16 years, with a male predominance of 44 patients (88%). The most common primary site was the border of tongue in 10 patients (20%). Tobacco use, either alone or in combination with smoking, was the most common risk factor observed. Level II nodes were most frequently involved 89%. The sensitivity of clinical examination, USG, and DW-MRI was 76%, 86%, and 98% respectively. On ultrasonography, loss of fatty hilum was observed in 95% and intranodal necrosis in 93%. DW-MRI demonstrated diffusion restriction in 98%. The mean ADC value was 0.918±0.077×10⁻³ mm²/s, which was statistically significant (p<0.001).

Conclusions DW-MRI demonstrated the highest sensitivity among the evaluated modalities. A combined approach improves detection of metastatic and occult cervical lymph nodes, thereby enhancing diagnostic accuracy.