Welkoborsky Hans-J
Department of Otorhinolaryngology, Head and Neck Surgery Nordstadt-Clinic, Academic Hospital, Hannover, Germany.
Curr Opin Otolaryngol Head Neck Surg. 2009 Apr;17(2):116-21. doi: 10.1097/MOO.0b013e3283297042.
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.
回顾过去12个月发表的颈部超声检查的重要进展，并阐明其对门诊超声检查的适应证和诊断准确性的影响。
在鳞状细胞癌患者的颈部筛查中，已描述了超声和双功能超声特征以识别淋巴结转移，即大小、形状、回声性、均匀性、无门征和门部血管、表面不规则、坏死区域、包膜外扩散证据、周边灌注模式、局灶性血管化缺陷和高搏动指数。传统超声、双功能超声和超声引导下细针穿刺活检（USgFNAB）相结合，总体准确率接近100%。已发现超声在甲状腺和甲状旁腺疾病的诊断及鉴别诊断、甲状旁腺腺瘤的定位以及甲状腺疾病的鉴别诊断中最为准确。然而，超声特征大多缺乏特异性。超声检查提供了通过USgFNAB在直视下获取细胞学材料的机会。
门诊超声检查是一种简单且有益的技术，会因检查者的经验而得到提升。负责患者的颈部外科医生可将此信息用于诊断和治疗管理。由于超声检查具有高准确性、无创性且无辐射暴露，在整个颈部任何病理性肿块的诊断及鉴别诊断以及任何外科手术前均需进行超声检查。未来的发展，即弹性成像，可能会进一步提高鉴别良性和恶性肿块的诊断准确性。
