Ultrasonography in the Treatment of a Pediatric Midline Neck Mass
ABSTRACT OBJECTIVE To assess the effectiveness of ultrasonography for determining which pediatric midline neck masses should be treated surgically. DESIGN Retrospective study. SETTING Tertiary care pediatric hospital. PATIENTS Pediatric patients with a midline neck mass who underwent ultrasonography from 2003 to 2011. MAIN OUTCOME MEASURES Demographics, ultrasonography, and surgical and pathology reports were studied. The ultrasonography findings and pathological analyses were compared. RESULTS One hundred twenty-two patients met the inclusion criteria. The most common diagnosis obtained by ultrasonography was thyroglossal duct cyst (48.4%), followed by reactive lymph node (27.9%). Ninety-five of 122 patients (77.9%) underwent surgery. Twenty-seven patients (22.1%) were treated nonsurgically. The diagnosis and characteristics obtained from ultrasonography were confirmed by surgical pathologic analysis in 84.2% of the surgical cases. Of the 95 patients who underwent surgery, 85 (89.5%) had a non-lymph node lesion diagnosed by ultrasonography and confirmed by pathologic analysis. Ultrasonography was only 66.1% accurate in specifically diagnosing thyroglossal duct cyst and 30.0% accurate in specifically diagnosing reactive lymph node when compared with surgical specimens. CONCLUSIONS Ultrasonography is helpful in determining the pediatric midline neck masses that need to be removed surgically. It is less helpful in determining the exact pathologic characteristics of the lesion.
Article: Neck Masses in ChildrenClinical Pediatrics 12/2013; 53(11). DOI:10.1177/0009922813512177 · 1.26 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To determine if ultrasound could differentiate between thyroglossal duct cysts (TGDC) and midline dermoid cysts (DC). Cohort study. A search of pathology reports yielded 91 patients with TGDC or midline DC. Ultrasound images were presented to a radiologist blinded to pathology who evaluated the following: 1) depth of lesion from skin, 2) maximum diameter, 3) dimensions, 4) midline location, 5) distance from base of tongue, 6) tract, 7) wall regularity, 8) wall thickness, 9) margin definition, 10) heterogeneity, 11) internal septae, 12) solid components, 13) intralesional Doppler flow, and 14) posterior enhancement. The predictive power of these variables was evaluated in a multiple logistic regression model. There were 53 TGDC and 38 DC. TGDC were significantly more likely than DC to have the following features: 1) smaller distance from base of tongue, 2) tract, 3) irregular wall, 4) ill-defined margin, 5) internal septae, 6) solid components, and 7) intralesional Doppler flow. Three clinically reliable ultrasound variables were independently able to discriminate between TGDC and DC. A predictive model was fashioned whereby each variable was scored as 0 or 1, with a total score calculated (septae + irregular wall + solid components = TGDC [or SIST] score). We propose a scoring system whereby 0 = suggestive of DC; 1 = suggestive of TGDC; and ≥2 = highly suggestive of TGDC. It may be possible to differentiate between TGDC and midline DC preoperatively using ultrasound. N/A. Laryngoscope, 125:998–1003, 2015The Laryngoscope 09/2014; 125(4). DOI:10.1002/lary.24934 · 2.03 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The embryology, presentation, imaging, and treatment of the thyroglossal duct cyst will be reviewed. Anatomic features and surgical technique to prevent complications and recurrence will be discussed. Included in the discussion will be the management of thyroglossal duct cyst malignancy and ectopic thyroid. Copyright © 2015 Elsevier Inc. All rights reserved.Otolaryngologic Clinics of North America 02/2015; 48(1):15-27. DOI:10.1016/j.otc.2014.09.003 · 1.34 Impact Factor