Biopsy of nonpalpable cervical lymph nodes: Selection criteria for ultrasound-guided biopsy in patients with head and neck squamous cell carcinoma

This article is designed to find an appropriate policy to select nonpalpable cervical lymph nodes in head and neck squamous cell carcinoma patients for ultrasound-guided aspiration biopsy (USB). According to the literature, generally used selection criteria are width of nodes > 10 mm, length-to-width ratio >2 and absent echo-rich hilum. In 562 nonpalpable nodes of 355 patients (mean age 60 y, range 20-92 y) with head and neck squamous cell carcinoma, a USB procedure was carried out. Nodes were classified according to dimensions and to echo pattern. Representative cytology was obtained in 489 nodes; 112 were classified as malignant. Of the 412 nodes with a width ≤10 mm, 79 were malignant. Width is the strongest predictor for malignancy and, if corrected for width, the length-to-width ratio is of no influence. Of the 142 nodes with an echo-poor centre, or an inhomogeneous pattern, 46% were malignant, compared to 13% of 342 nodes with an echo-rich centre. It is concluded that selection of lymph nodes of the neck of patients with squamous cell carcinoma of the head and neck should be based on width and echo pattern. We advise subjecting nodes with an echo-rich centre or homogeneous pattern and a width ≥4 mm to USB, and also subjecting nodes with an echo-poor centre or inhomogeneous pattern with a width ≥3 mm to USB.