Case History: 68 Year old male patient was admitted to the nearest hospital for excision of a small basaliom on the skin of the face. By performing routine examination a 2.5 millimeters mass was also detected in front of the lower third of the left SCM muscle with negative ORL status. After uneventful excision of the small basaliom the patient underwent aspiration cytology from the neck mass. Result: after HE staining there were in serous fluid mononuclear and histiocyter cells and some washed red blood cells. Dg: the cytological appearance represented fluid content of a cyst. Without having any epithel cells further diagnosis concerning the cyst wall is not possible. (Solitar cyst in this anatomical area?) Patient underwent removal of the neck mass. Histology: metastasis of papillary carcinoma. Patient was admitted to another institution for further management of his disease. Szent Rókus Hosp. and Institutions, Budapest, Hungary Management after admitting the patient to our Department : - US of the neck inclusive thyroid glands - Scintigraphy of the thyroid gland - Thyroid hormone level - TG - Surgery: MRND l.s. type III. with central compartment dissection, total bilateral thyreoidectomy with preservation and preparation of the recurrent nerves, preserving at least two parathyroids. Symposium on Statement of Head and Neck Cancer, January 27-28th, 2006 Frankfurt am Main MODERN TREATMENT OPTIONS Detection of lymph node metastasis (Moderated by P. Ambrosch, Lecture by T. J. Vogl, Panelists: P. J. Bradley, K. Albegger, G., Lichtenberger) R L 200 MBq Tc-99m-pertechnetet

Symposium on Statement of Head and Neck Cancer, January 27-28th, 2006 Frankfurt am Main MODERN TREATMENT OPTIONS Detection of lymph node metastasis (Moderated by P. Ambrosch, Lecture by T. J. Vogl, Panelists: P. J. Bradley, K. Albegger, G., Lichtenberger) Postoperative examination: Scintigraphy: no residual thyroid tissue US: no residual thyroid tissue. Postoperative therapy: J 131 isotope therapy (Dosage: 2,6 GBq ) Follow up: One Year. The patient is free of complains and symptoms. TG: not detectable, US investigation: negative. However we think that the definitive operation and the postoperative management will ensure good chances for the patient for total recovery. (As the metastasis of papillary carcinoma gives a special appearance of the small vessels inside the node, a specially trained radiologist probably would have been able to reflect the attention after performing US that it may have been a papillary carcinoma metastasis). It was correct in this case to perform aspiration cytology however there was not the likelihood that there is really a solitaire cyst in this anatomical area. Probably the cytological diagnosis may have been more accurate by performing ultrasound guided aspiration. It is important by setting up the diagnosis that the cytological diagnosis has to be considered and compared to the clinical appearance and to the evaluation of the neck by physical examination. CONCLUSION

Ultrasound and FNL aspiration in the evaluation of neck metastases. Inspection and Palpation Sonography Doppler and Color Doppler Sonography Palpation (69%), Sensitivity of the Sonography (90-97%), CT (83%) MRT (83%) The Ultrasound diagnostic is fast, not invasive, side effect-free for the patient and dynamic. Color coded Doppler Sonography Highly dissolving sound heads (7.5 MHz) for the investigation of the neck region (width approximately 1 cm and length 4-5 cm to be used) US investigation of Lymph nods smaller than 8 mm. US guided FNA US investigation of malignant lymphomas Lymph node metastases of planocell ca. - Sonographic criteria Extra-capsular growth of the neck node metastases Capsule rupture Differential diagnosis (scar neurome, thread granulom) Importance of ultrasound by wait and see policy Solid tumors (glomus jugulare, glomus caroticum tumor)  color coded Duplex sonography Lymphangiom Haemangiom/vascular malformation Lypom Haematom TeratomNeurinom, neurofibroma, Median neck cyst Lateral neck cyst Epidermoid cysts US-guided FNA The sensitivity of US-guided FNA for the clinical NO neck between %.