[Ultrasound of hypopharyngeal and oesophageal cancer: possibilities and limitations to staging and planning of therapy]

Usefulness of ultrasound for assessing the primary tumor of hypopharyngeal carcinoma

Objectives

To clarify the usefulness of ultrasonography for detecting hypopharyngeal cancer.

Study Design

Cross-sectional study.

Methods

The study included 95 patients who underwent pre-treatment ultrasonography. We evaluated the usefulness of ultrasonography for detecting primary hypopharyngeal carcinoma of each T stage and subsite, and for assessing extrahypopharyngeal invasion. Additionally, we determined the efficacy of color Doppler for evaluating primary hypopharyngeal carcinoma.

Results

The patients comprised 93 men and 2 women with a mean age of 67.5 years. The T stage (primary tumors) was T1 in 29 patients, T2 in 22, T3 in 9, and T4 in 35. Primary sites with a T stage over T3 were detected using ultrasonography in 17 patients.Regarding primary subsites, postcricoid tumors were assessed most easily (64%), while posterior wall tumors were the most difficult to assess (25%). In 15 of 17 patients, the evaluation of extrahypopharyngeal invasion by ultrasonography matched up precisely with computed tomography findings. In addition, abnormally increased blood flow in primary hypopharyngeal cancers was recognized by color Doppler, and could be used to predict subsites.

Conclusions

Cancers at T3 and T4 hypopharyngeal primary tumors and their extrahypopharyngeal invasion were detectable using ultrasonography. Furthermore, ultrasonography was useful for assessing postcricoid tumors that were difficult to observe by flexible laryngoscopy.

Level of Evidence

4.

Ultrasound-Guided Needle Biopsy for Diagnosis of Advanced-Stage Malignancies of the Upper Aerodigestive Tract

Objective

Traditionally, direct laryngoscopy confirms stage and tissue diagnosis prior to treatment planning. Patients who are frail or have tenuous airway anatomy may incur risks while undergoing anesthesia. Further, direct laryngoscopy is scheduled after initial examination, introducing diagnosis delay. This study investigates the impact of ultrasound examination with guided needle biopsy compared with traditional operative biopsy.

Study Design

Case series.

Setting

Tertiary head and neck clinic.

Subjects and Methods

The records of patients at the Veterans Affairs Medical Center Memphis and Regional One Health who had supraglottic, oropharyngeal, and hypopharyngeal cancer that was diagnosed by ultrasound needle biopsy were reviewed from 2011 to 2016. Demographics, stage, biopsy results, and treatment were abstracted.

Results

Seventeen patients who underwent ultrasound-guided needle biopsy of the primary site were included. Average age was 63 years old, and 65% of patients were stage T4 (11/17). Needle biopsy yielded malignant cells in 76% (13/17). Eleven patients were included in subsequent analysis because 6 patients underwent needle biopsy only. Fisher exact test showed no difference between the 2 methods (P = .27). Sensitivity was 86% and specificity was 100%. Seven patients had a median potential delay in diagnosis of 10 days.

Conclusions

Ultrasound can be used effectively to obtain a tissue diagnosis, circumventing an operative biopsy. Moreover, ultrasound may provide additional imaging details to support accurate staging. This strategy may prove worthwhile to cut costs and reduce delay to staging, reduce risk for those with contraindications to anesthesia, and increase staging accuracy via enhanced imaging details.

[Ultrasound of the larynx, hypopharynx and upper esophagus]

Sonography is an integral part of the routine diagnosis of diseases of the head and neck area. Ultrasound plays an important role in particular in the diagnosis, treatment and follow-up of head and neck cancer. Sonographic imaging of the larynx, hypopharynx and upper esophagus is often difficult due to the anatomical conditions. Therefore, CT and MRI are performed as the imaging techniques of first choice for diseases of these organs. In addition to the well-established transcutaneous ultrasound, endoscopic endoluminal ultrasound has developed as a promising new technique in recent years. Hollow organs can be displayed in high resolution transcutaneously and endoluminally. Thus, the attending otolaryngologist can use endoscopy and ultrasonography for accurate surgical planning. The aim of the present paper is to present the possibilities and limitations of ultrasonography of the larynx, hypopharynx and upper esophagus.

Sonographic assessment of hypopharyngeal carcinoma: preliminary study

OBJECTIVES

This study investigated the ability of sonography for diagnosis of hypopharyngeal carcinoma.

METHODS

Between November 2008 and January 2010, 34 consecutive patients with hypopharyngeal carcinoma (34 tumors) were examined by sonography. The visualization capability of sonography was evaluated by grading criteria of "excellent," "good," "moderate," and "poor" in comparison with computed tomography (CT). Localization of the primary tumor foci and intrahypopharyngeal and extrahypopharyngeal invasion were initially assessed by sonography and confirmed with surgical and pathologic findings. Laryngeal movement was observed on real-time sonography and compared with endoscopic findings.

RESULTS

On sonography, 29 of the 34 lesions (85.3%) were graded excellent, similar to the shapes and dimensions of the tumors on CT. Localization was correctly undertaken in 26 of the 28 foci resected (92.9%), with excellent agreement between sonography and surgical and pathologic findings (κ = 0.823; P < .001). In evaluating intrahypopharyngeal and extrahypopharyngeal invasion with sonography, the sensitivity and specificity were 90.9% and 82.4%, respectively, for intrahypopharyngeal intersubsite spreading, 50.0% and 96.2% for diagnosis of thyroid cartilage destruction, both 100% for evaluation of cervical esophagus, neck soft tissue, and thyroid gland involvement, and 76.9% and 100% for assessment of hemilarynx fixation.

CONCLUSIONS

Sonography has a similar role in visualization of hypopharyngeal carcinoma as CT and is satisfactory in localization of the primary focus and assessment of tumor extension inside and outside the hypopharynx.

[Staging of esophageal cancer using ultrasound]

The early diagnosis of esophageal cancer is crucial for the prognosis of the disease. In contrast to cancer of the upper aerodigestive tract, the mucosa of the esophagus is not visible without the appropriate equipment. In addition to endoscopy, imaging of the esophagus is crucial for early detection of the esophageal cancer. Ultrasound of the esophagus can be performed easily and--in contrast to other imaging techniques--without side effects. Different modes of ultrasound can be performed. First, transcutaneous ultrasound allows one to detect tumors of the upper esophagus and its passage into the hypopharynx. Second, endosonography allows one to detect pathologies of the other esophageal regions including the passage into the stomach. The present review discusses the impact of both techniques against the background of the international literature.