Contrast-enhanced ultrasound in the diagnosis of head and neck squamous cell carcinoma

The study objective is to evaluate the capacity of contrast-enhanced ultrasound in the diagnosis of head and neck squamous cell carcinoma.

Materials and methods. We examined 34 patients with head and neck tumors (or suspected of having a tumor) using contrast-enhanced ultrasound imaging with sulfur hexafluoride.

Results. Contrast enhancement of primary and recurrent tumors (developed within 3 months since the end of treatment) was characterized by rapid wash-in (including peak enhancement) and wash-out of contrast agent. However, recurrent tumors (developed within 3 months after treatment) demonstrated slightly slower wash-in than primary tumors. In patients with suspected relapse, which was not confirmed by histological examination, contrast agent accumulated only in the surrounding tissues and did not penetrate into the fibrous infiltrate; there were no wash-in and wash-out phases (although this did not exclude the presence of small tumors in the infiltrate). By contrast, tumors demonstrated rapid achievement of peak enhancement and fast wash-out. Laryngeal and laryngopharyngeal tumors accumulate and release contrast agent like any other oropharyngeal squamous cell carcinomas. Laryngeal cartilages have high echogenicity and don’t accumulate contrast agent. Tumor-altered vocal cords accumulate contrast agent, which significantly improves the visualization. Intact vocal cords appear as hyperechogenic symmetric structures on B-scans. Contrast-enhanced ultrasound imaging allows better visualization of the vocal cords. Contrast-enhancement can significantly improve the diagnostic value of ultrasound examination of the larynx, especially when B-scanning is hindered by some anatomical features (such as large Adam’s apple) or ossification of laryngeal cartilages.

Conclusion. Contrast-enhanced ultrasound imaging of the head and neck is a highly promising diagnostic tool, although it requires further evaluation. Improved visualization with contrast-enhancement increases the diagnostic value of the method for the differentiation between various tumors and fibrotic changes and detection of tumor spread to the laryngeal cartilages, which is important for surgical treatment and planning anticancer therapy.

1. Gramiak R., Shah P.M. Echocardiography of the aortic root. Invest Radiol 1968;3(5):356–66. PMID: 5688346.

2. Enhancing the role of ultrasound with contrast agents. Ed. by R. Lencioni. Springer-Verlag Italia, 2006. 262 p.

3. Novikov N.E. Contrast-enhanced ultrasound. History of development and modern capabilities. Rossiysky elektronny zhurnal luchevoy diagnostiki = Russian Electronic Journal of Radiology 2012;2(1):20–8. (In Russ.).

4. Chechetkin A.O., Druina L.D. Capabilities of contrast-enhanced ultrasound in angioneurology. Annaly klinicheskoy i eksperimentalnoy nevrologii = Annals of Clinical and Experimental Neurology 2015;9(2):33–7. (In Russ.).

5. Fomina S.V., Zavadovskaya V.D., Yusubov M.S. Contrast agents for ultrasound examination. Bulleten sibirskoy meditsiny = Bulletin of Siberian Medicine 2011;10(6):137–42. (In Russ.).

6. Sidhu P.S., Cantisani V., Dietrich C.F. et al. The EFSUMB guidelines and recommendations for the clinical practice of contrastenhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version). Ultraschall Med 2018;39(2):e2–e44. DOI: 10.1055/a-0586-1107. PMID: 29510439.

7. Food & Drug Administration. March 2016 – approved drug productlist. Available at: http://www.fda.gov/downloads/drugs/developmentapprovalprocess/ucm071120.pdf.

8. Lumason prescribing information. Available at: http://imaging.bracco.com/sites/braccoimaging.com/files/technica_sheet_pdf/US-20160330-LUMASON-PI_0.pdf.

9. Seitz K., Strobel D. A milestone: approval of CEUS for diagnostic liver imaging in adults and children in the USA. Ultraschall Med 2016;37(3):229–32. DOI: 10.1055/s-0042-107411. PMID: 27276056.

10. Claudon M., Dietrich C.F., Choi B.I. et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013;34(1):11–29. DOI: 10.1055/s-0032-1325499. PMID: 23129518.

11. Piscaglia F., Nolsøe C., Dietrich C.F. et al. The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 2012;33(1):33–59. DOI: 10.1055/s-0031-1281676. PMID: 21874631.

12. Trotta B.M., Pease C.S., Rasamny J.J. et al. Oral cavity and oropharyngeal squamous cell cancer: key imaging findings for staging and treatment planning. Radiographics 2011;31(2):339–54. DOI: 10.1148/rg.312105107.

13. Ferlay J., Shin H.R., Bray F. et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127(12):2893–917. DOI: 10.1002/ijc.25516. PMID: 21351269.

14. Van Monsjou H.S., Balm A.J.M., van den Brekel M.W.M., Wreesmann V.B. Oropharyngeal squamous cell carcinoma: a unique disease on the rise? Oral Oncol 2010;46(11):780–5. DOI: 10.1016/j.oraloncology.2010.08.011. PMID: 20920878.

15. Klussmann J.P., Weissenborn S.J., Wieland U. et al. Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas. Cancer 2001;92(11):2875–84. PMID: 11753961.

16. Gillison M.L. Human papillomavirus-associated head and neck cancer is a distinct epidemiologic, clinical, and molecular entity. Semin Oncol 2004;31(6):744–54. PMID: 15599852.

17. Chaturvedi A.K., Engels E.A., Pfeiffer R.M. et al. Human papillomavirus and rising oropharyngeal cancer incidence in the Unated States. J Clin Oncol 2011;29(32):4294–301. DOI: 10.1200/JCO.2011.36.4596. PMID: 21969503.