Ultrasonogram in Acute Appendicitis, A Surgeon’s Perspective: Original Article

Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same. Materialsand methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay. Observations:It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/-14.4 years. Mean hospital stay was 3.68 +/-2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients. Conclusion:USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.

Comparison of Postmortem Analysis of Anomalous Fetuses with the Prenatal Ultrasonography Findings

Background: Congenital anomalies cause around 10–15% of perinatal deaths in India. At present, these fetal deaths are onlyevaluated with ultrasonography (USG) findings. With this study, we aimed to do the postmortem analysis of these anomalousfetuses and compare the findings with antenatal ultrasound findings.Materials and Methods: A descriptive study carried out with 43 anomalous fetuses over 1½ years period in a tertiary careinstitute by comparing the postmortem analysis of anomalous fetuses with the prenatal USG findings.Results: Among the 43 cases, 41 had antenatal USG taken. In 11 cases, autopsy confirmed the USG findings and autopsyshowed extra findings in 16 cases. Antenatal USG was normal in 12 cases, but autopsy only identified anomalies. In two cases,autopsy detected no anomalies. Among 41 cases, 12 cases with normal antenatal USG had significant findings and 11 caseswith abnormal USG had new findings after physical examination and X-ray evaluation.Conclusion: Fetal autopsy helps in identifying many external and internal malformations which were undetected by antenatalUSG. Fetal autopsy can be useful in 95% of cases – it can either confirm or add findings. Limited fetal autopsy can benefit in56% of cases. The study shows that in majority of cases, the limited fetal autopsy itself will detect many anomalies undetectedby the USG.

Placental thickness and its correlation with estimated foetal weight: a cross-sectional study in a tertiary care centre in South India

Background: The placenta is a multifaceted organ which modulates and modifies the maternal environment resulting in foetal development. It could be assumed that a healthy placenta culminates in a healthy foetus. Hence the morphometric analysis of a placenta during sonogram is inevitable. The aim of the study was to estimate the relationship between placental thickness and estimated foetal weight.Methods: The study was a cross-sectional study and included 450 antenatal women attending the department of Obstetrics and Gynaecology, Tirunelveli Medical College from May 2013 to May 2014. These women had regular cycles with a known Last menstrual period and a singleton foetus. After ethics committee approval, meticulous history including age, parity, demographic factors and past history were recorded. After obtaining consent, these women underwent placental thickness measurement between 14-40 weeks of pregnancy.Results: In the study mean placental thickness between the ranges of 11-49mm was 28.7mm and mean estimated foetal weight was 1.421kilogram. The correlation between the two was 0.943. Hence the positive correlation between the placental thickness and foetal weight is confirmed (p value <0.001).Conclusions: Determining the estimated foetal weight is an important reason for doing a sonogram, especially in third trimester. Placental thickness measured at the level of umbilical cord insertion can serve as an additional parameter in estimating foetal weight in addition to the foetal parameters, since there is a linear correlation between placental thickness and foetal weight.

Sonographic Evaluation Of Plantar Fascia Following Low-Level Laser Therapy In Plantar Fasciitis

Background: Plantar fasciitis is the most common cause of inferior heel pain resulted from repeated trauma leading to a microscopic tear in the plantar fascia. There is a need to study the non-invasive nature of low-level laser therapy in reducing pain and enhance healing. Therefore the study aimed to find out the efficacy of low-level laser therapy in plantar fasciitis. Methods: The study design is a pre-post experimental design. Thirty patients(21 females & 9 males) with plantar fasciitis who fulfilled the inclusion criteria participated in the study. Baseline parameters using musculoskeletal ultrasonogram of the plantar fascia, numerical pain rating scale, ankle joint mobility testing and foot and ankle ability measure questionnaire were recorded. Subjects in the control group received ultrasonic therapy, while the experimental group received irradiation of Low-Level Laser Therapy (LLLT) for two weeks comprising 12 sessions and the above-specified outcome measures were re-evaluated after two weeks. Results: The results showed significant improvement in pain severity (p<0.04) and ankle dorsiflexion range of motion (p<0.00) and ankle ability measure but no significant change in plantar fascia thickness following low-level laser therapy was observed. A positive correlation (r=0.9) was found between plantar fascia thickness and post foot and ankle ability measure-ADL scores (p=0.02). Conclusion: The findings suggest that low-level laser therapy helps in pain reduction and improving range of motion in plantar fasciitis with minimal effect on the thickness of plantar fascia.

A descriptive study on solitary nodular goitre

Background: Solitary nodular goitre is clinically defined as a single nodule in otherwise normal thyroid gland. It can be benign or malignant. Solitary nodule has a higher risk of malignancy (15- 20%) when compared to multi-nodular goitre (3-5%). Aim: We conducted a study to evaluate the clinical and radiological factors associated with occurrence of malignancy in Solitary Nodular Goitre (SNG); to find out the incidence of SNG in this part of North Chennai; to analyze the correlation of preoperative cytological and postoperative histopathological results. Materials and methods: It was a prospective study on fifty patients who were clinically diagnosed as SNG. All patients were evaluated with an Ultrasonogram (USG) Thyroid and Fine Needle Aspiration Cytology (FNAC). After surgery, the Histopathological Examination (HPE) reports were compared with the FNAC findings. Results: SNG was more common in the age group of 21-40 years. 86% of SNG patients were females. The incidence of malignancy in SNG this study was 12% which commonly involved males. Among the malignancies, papillary carcinoma was the most common and Hashimoto’s thyroiditis was found to be associated with it. The presence of microcalcifications and paratracheal nodes in USG were more in favour of malignancy. The FNAC report correlated well with the HPE reports, the accuracy of FNAC being 90% in this study. Conclusion: SNG has a high risk of malignancy, especially in males and the most common type being papillary carcinoma. FNAC is the gold standard pre-operative investigation that is well correlated with post operative HPE results

Ultrasonographic Discrimination of Benign and Malignant Breast Lumps with Histopathological Correlation.

Background: A lump in the breast is a cause of great concern. High frequency high resolution ultrasonogram helps in its evaluation. With major advances in ultrasonographic technology during the past 20 years, ultrasonogram can now distinguish benign and malignant solid breast lumps. Knowledge of the specific benign and malignant ultrasonographic characteristics of breast lumps is imperative for accurate diagnosis and optimal patient management. Objective: To determine the validity of ultrasound in the assessment of palpable breast lump by detecting the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasonogram in distinguishing benign and malignant breast lumps. Materials and Methods: This cross sectional study was done in the department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka in collaboration with the department of Pathology of BSMMU for histopathological correlation during July 2008 to June 2009. A total of 100 patients who were clinically suspected of having breast lump were included in this study. Data on clinical presentation, ultrasonographic findings including histopathological reports were collected and documented in structured forms. Analysis was done using SPSS 13.0 version. Results: The study was done in 100 women of 18–70 years of age with mean age 41.46 ± 11.62 years. Breast lumps were found with associated clinical presentation of pain in 26 (26%) cases, discharge in 12 (12%) cases, skin changes in 28 (28%) cases, nipple retraction in 10 (10%) cases, and palpable lymph nodes in 10 (10%) cases. On ultrasonogram, lesions were diagnosed as benign in 62% cases and malignant in 38% cases. Out of sonographically diagnosed 62 benign lesions 58 (93.5%) were also proved benign histopathologically and 4 (6.5%) as malignant. Out of 38 sonographically malignant lesions, 34 (89.5%) were also proved as malignant histopathologically and 4 (10.5%) as benign. Conclusion: Ultrasonographic findings of benign and malignant breast lumps correlated well in most of the cases with the histopathological results. Therefore, it can be concluded that ultrasonogram is a useful imaging tool to discriminate benign and malignant breast lumps and thus we can reduce unnecessary breast biopsies, patient discomfort and anxiety in addition to increase in cost of the patient.

A randomized prospective comparative study of nerve stimulator and ultrasonogram in popliteal sciatic nerve block for ankle and foot surgeries.

Background: Regional blocks in the field of anaesthesia were done traditionally with paraesthesia technique. To overcome the demerits with paraesthesia technique, nerve locator was applied for nerve blocks. Later, the application of ultrasonogram for regional blocks got the real time imaging of the nerves and drug administration. This resulted in publications of numerous studies with variable results. Therefore we planned to compare ultrasonogram and nerve locator in popliteal sciatic nerve block in our population. Methods: A prospective, randomized, observer blinded study was planned to compare the nerve stimulator (Group N) and ultrasound (Group U) on duration of „block technique‟, number of needle reinsertions in popliteal sciatic nerve block for ankle and foot surgeries. We included all consented patients aged ≥18 years of both genders belonging to ASA I to III and excluded pregnant mothers, diabetes mellitus, neuropathy, chronic opioid use, positioning difficulty, coagulopathy, nerve block contraindications, local anaesthetic allergic patients. Results: The duration of block technique in Group U = 262.00 ± 108.36 Seconds and Group N = 715.16 ± 234.66 Seconds with statistically significant P value = 0.0001. The average number of needle reinsertions in Group N = 6.05 ± 2.31 and Group U = 2.46 ± 1.11 with statistically significant p value of 0.0001. Therefore the time taken to perform the block and the number of needle reinsertions in Group U is shorter than the Group N. Conclusion: The duration of block technique and number of needle reinsertions are better with ultrasound. Though the onset of motor and sensory blockade were better with ultrasound success rate is not significantly different.

Treatment of Superficial Peroneal Nerve Entrapment Syndrome under Local Anesthesia using Ultrasonogram / 대한족부족관절학회지

PURPOSE: To review the outcomes of surgical treatment for superficial peroneal nerve entrapment. MATERIALS AND METHODS: Ultrasonogram was used for diagnosis and surgical treatment. Seven superficial peroneal nerve entrapment were surgically treated with follow up of average 16 months (range, 6~29 months). Three patients were male and four patients were female with mean age 36.7 years (range, 19~51 years). Four cases developed after repetitive ankle sprain and three cases had no etiology. RESULTS: Operation was performed mini-open and subcutaneous fasciotomy under local anesthesia. The results were excellent in two cases, good in four cases, fair in one case. CONCLUSION: Ultrasonogram was useful for diagnosis and surgical treatment of superficial peroneal nerve entrapment syndrome.

Proliferating Trichilemmal Tumor of the Knee Mimicking Prepatellar Bursitis on Ultrasonogram: A Case Report

Proliferating trichilemmal tumor is a rare benign tumor of skin appendage. It is usually solitary, more common in women after the fourth decade of life, and almost exclusively confined to the scalp and back of the neck. We report herein an unusual case of proliferating trchilemmal tumor which occurred on the knee.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

Analysis of clinical characteristics of cornual pregnancy / 대한산부인과학회지

OBJECTIVE: To determine the efficacy of ultrasonogram in the detection of cornual pregnancy and the factors that might be affected on early diagnosis. METHOD: We studied 26 cases which were diagnosed as a cornual pregnancy from Jan, 1, 2000 to Dec, 31, 2004 at department of Obstetrics and Gynecology, St. Vincent's Hospital, the Catholic University of Korea. We compared two groups about clinical characteristics and outcomes. One group (A group) was diagnosed as cornual pregnancy before beginning of treatment, another group (B group) was not diagnosed as cornual pregnancy until operation. RESULTS: A group was 8 cases (30.8%) and B group was 18 cases (69.2%). There were no significant differences in age (33.0+/-6.21 years : 31.0+/-5.82 years), duration of amenorrhea (7.32+/-1.07 weeks : 8.90+/-5.44 weeks), previous cesarian section history (25.0% : 27.8%), present myoma (12.5% : 11.1%) and abdominal pain (50% : 77.78%), vaginal bleeding (50% : 55.6%), shock (0% : 27.8%) between two groups. There were significant differences in parity (1.63+/-0.74 : 1.0+/-0.77, p=0.032), number of abortions (2.25+/-1.16 : 1.11+/-1.18, p=0.016), previous history of ectopic pregnancy (37.5% : 0%, p=0.022). Of the method of treatments, only cornual resection (50% : 94.4%) showed significant differences between two groups. CONCLUSION: 30.8% of cornual pregnancy was early diagnosed by ultrasonogram. The important early detective factors for cornual pregnancy might be parity, previous ectopic pregnancy history and abortion history. Therefore if the patient has the previous ectopic pregnancy and abortion history, she can visit early to the hospital and the doctors do pay attention to the possibility of cornual pregnancy.

Two cases of arachnoid cyst of prenatal diagnosis / 대한산부인과학회지

Intracranial arachnoid cysts are collections of clear fluid within the arachnoid membrane because of nondisjunction or duplication of the structure. They are rare, represent only 1% of intracranial masses in newborns. Etiologically, they are thought to be due to maldevelopment of the arachnoid or secondary to trauma or infection. The arachnoid cyst by ultrasonogram shows characteristic well capsulated homogeneous hypoechoic cyst. Many arachnoid cysts remain asymptomatic, however, and become symptomatic later in life to cyst growth-resulting in a compression, displacement and irritation of the surrounding structures. So, early diagnosis and treatment of these cysts are important. We present two cases of arachnoid cysts diagnosed in utero by ultrasonogram. In one case, postnatal MRI was checked and confirmed arachnoid cyst with choroid plexus cyst. And other case, postnatal brain USG was checked and diagnosed arachnoid cyst. Both children are asymptomatic, and presents normal development until now. But latter children underwent surgical treatment due to persistent huge cyst and hydrocephalus.

A Case of Osteogenesis Imperfecta Type II Misdiagnosed as a Camptomelic Syndrome in Uterus / 대한주산의학회잡지

Osteogenesis imperfecta is a very rare heterogeneous disorder and its overall incidence is estimated at 1/25,000 births. It is characterized by bone fragility, loss of bone mass, blue sclera, impaired hearing, poor dentition and hypermobile joints. It is categorized into 4 types and we should distinguish it from other skeletal disorder such as the Camptomelic syndrome. We recently experienced a case of osteogenesis imperfecta type II, misdiagnosed as the Camptomelic syndrome in uterus by ultrasonogram and delivered by Cesarean section near term. We report this case with a brief review of the literature.

Acute Appendicitis in Children: Comparison between Present and 10 Year Ago

Appendicitis is the most common surgical emergency in childhood and the technologic advances of modern medicine have affected the diagnosis and treatment of appendicitis. This study is to evaluate the differences in diagnosis and treatment of appendicitis between present and 10 year ago. The authors retrospectively reviewed the medical records of patients who underwent appendectomy under the diagnosis of the acute appendicitis from July 1993 to June 1995 (Group A, n = 78) and from July 200 to June 2005 (Group B, n = 105). There are no differences between group A and B in mean age (8.5 +/-3.6 vs. 9.3 +/-3.1 year), duration of symptoms (3.0 +/-3.2 vs. 2.6 +/-3.8 days), and postoperative hospital stay(6.6 +/-4.8 vs. 5.8 +/-3.6 days). Preoperative abdominal ultrasonogram and/or computed tomogram was performed in 7 patients (9.0 %) of group A and in 51 patients (58.5 %) of group B. Thirty-six patients (34.3 %) of group B underwent laparoscopic appendectomy, but none in group A. Incidence of a histologically normal appendix decreased from 15.8 % in group A to 4.8 % in group B (p =0.018). This study suggests that utilization of abdominal ultrasonogram or computed tomogram in preoperative evaluation become more popular and surgical treatment of acute appendicitis become more minimally invasive. The rate of negative appendectomy was also reduced compared with 10 year ago.

Ultrasonographic Segmentation of Cervical Lymph Nodes Based on the Graph Cut with Elliptical Shape Constraint / 航天医学与医学工程

Objective To propose a modified graph cut algorithm under the elliptical shape constraint to segment the ultrasonogram of cervical lymph nodes. Methods Since cervical lymph nodes were usually oval-shaped, the prior of the elliptical shape information, which was expressed as a distance function, was used to constrain the cut cost of the graph cut algorithm. The initially segmented contour was fitted with an ellipse to get the constraint. Then a certain segmentation was obtained by minimizing the cut cost function constrained with the elliptical prior. This procedure was iterated until it to be convergent. Results Under the same user input, this algorithm successfully segmented nodes on the low contrast ultrasonograms, while the traditional graph cut approach failed. For 20 ultrasonograms, with the average minimum Euclidean distance (AMINDIST) measure and the Hausdorff distance measure, these two distances between contours manually delineated by the radiologist and those segmented by this algorithm were far less than the distances resulted from the traditional graph cut algorithm. Conclusion It is indicated that utilizing the elliptical shape constraint prior can obviously improve the graph cut algorithm for segmenting cervical nodes on ultrasonograms.

Amniotic Chromosomal Analysis in Pregnant Women Identified by Triple-Marker Testing as Screen Positive / 대한진단검사의학회지

BACKGROUND: Maternal serum triple marker screening (alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol) can detect 60-70% of Down syndrome and 60% of Edwards syndrome. Previous studies have reported that positive serum screening is related to other fetal chromosomal abnormalities, pregnancy complications, and adverse outcomes. We determined the incidence and karyotype of chromosomal abnormalities in screen positive women and evaluated a relationship between chromosomal and ultrasonographic abnormalities. METHODS: Of the 49,806 pregnant women between 15 and 23 weeks' gestational age who received prenatal serum screening with a cut-off value (a risk of 1:270 for Down and 1:100 for Edwards syndrome), 2,116 (4.2%) and 196 (0.4%) were screen positive for Down syndrome and for Edwards syndrome, respectively. Chromosomal analysis in amniotic fluid was performed for 1,893 (89.5%) of the Down positive and 140 (71.4%) of the Edwards positive pregnant women. Ultrasonographic examination was performed to detect fetal abnormalities. RESULTS: Eighty-three cases of chromosomal abnormalities including 40 trisomy 21 (2.1%) and 43 other chromosomal abnormalities (2.3%) were identified in the Down screen positive. Other chromosomal abnormalities included 9 numerical and 34 structural abnormalities. Ten cases of chromosomal abnormalities (9 trisomy 18 and 1 trisomy 9) were detected in the Edwards screen positive. Ultrasonographic abnormalities were found more frequently in the women who had chromosomal aberrations. CONCLUSIONS: These data suggest that 4.4% of the Down screen and 7.1% of the Edwards screen positive pregnancy have fetal chromosomal abnormalities. Positive Down screening results reflect a relatively high probability of other abnormalities except trisomy 21. Edwards screen positive group show a low frequency of other chromosomal abnormalities except trisomy 18. A simultaneous use of maternal serum screening and ultrasonograms could be useful for the diagnosis of fetal abnormalities.

Invasive Papillary Carcinoma of the Breast Presenting as Post-Traumatic Recurrent Hemorrhagic Cysts

We report the sonographic features of an intracystic papillary carcinoma of the breast presenting as recurrent hemorrhagic cysts following trauma. A 56-year-old woman presented with palpable breast masses after a traumatic event; sonography showed multiple, well-defined, hemorrhagic cysts. Hemorrhagic fluid was evacuated by fine needle aspiration with no residual lesions. Cytology was negative for malignancy. Five months later, the mass reappeared; sonography demonstrated multiple cysts with solid nodules. US-guided core biopsy and surgery revealed invasive papillary carcinoma. We suggest close follow-up of cystic masses, even with negative cytology, and performance of surgical excisional biopsy in cases of rapid refilling after aspiration.

ACase of the Patau Syndrome Diagnosed in Second Trimester / 대한주산의학회잡지

Patau syndrome is trisomy 13, one of the most common autosomal aberration associated with multiple congenital anomalies. Because trisomy 13 is generally associated with severe congenital anomalies and postpartum poor prognosis, antenatal diagnosis through antenatal ultra-sonogram and triple screening marker is very important. We present one case of trisomy 13 with abnormal ultrasound finding, holoprosencephaly, microcephaly, cleft lip and palate. And confirmed chromosomally with pregnancy termination.

The Usefulness of Ultrasound-Guided Fine Needle Aspiration Cytology of Impalpable Neck Nodes in Patients with Lung Cancer / 결핵

BACKGROUND: In lung cancer patients, the presence of metastatic neck nodes is a crucial indicator of inoperabilty. So thorough physical examination of neck is always mandatory, but sometimes those are hardly palpable even by the skillful hand. Ultrasonography is a useful diagnostic method in detection of small impalpable lymph nodes and in guidance of fine needle aspiration biopsy. In this study we evaluated the clinical usefulness of ultrasonography(USG) and ultrasound-guided fine needle aspiration cytology(US-FNA) in lung cancer patients without palpable neck nodes. METHODS AND MATERIALS: From Sep 2002 to Sep 2003, 36 non-small cell lung cancer patients (20 adenocarcinoma, 16 squamous cell cancer) and 10 small cell lung cancer patients without palpable neck nodes on physical examiation were enrolled. patients who had contralateral mediastinal nodal enlargement(>1cm) on chest CT were excluded. After the routine check of USG on the neck, US-FNA was done in cases with enlarged neck nodes (> or =5 mm in the short axis). The presence of enlarged lymph node on USG, and of malignant cells on cytology were evaluated by the histological type and the patients' clinical stage of lung cancer. RESULTS: Among 36 non-small lung cell cancer patients, 14 (38.8%) had enlarged neck nodes on USG, and 5 of 10 small cell lung carcinoma patients. The mean diameter of the neck nodes was 9.8 mm (range, 7-12 mm). US-FNA of 14 non-small cell lung cancer patients revealed tumor cells in eight patients (57.1%). In 5 small cell lung cancer pateints, tumor cells were found in all cases. By the result of US-FNA, the clinical stage of 8 out of 36 (22.2%) non-small cell lung cancer patients had changed, including two cases of shift from the operable IIIa to the inoperable IIIb. In small cell lung cancer patients their clinical stage was not changed after US-FNA, but their pathological diagnosis was easily done in two cases, in whom endobronchial lesions were not found on bronchoscopy. CONCLUSIONS: USG and US-FNA of neck node seem to be safe, sensitive and cost-effective diagnostic tools in the evaluation of lung cancer patients without palpable neck nodes.