الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Ultrasound proves a simple, non- invasive, effective study for
quick and easy assessment of the target organ and it is readily
available in most hospitals, only by its routine and regular use the
exact benfits will be demonstrated and perhaps when the
documentatin of its application grows, so that the accuracy of
ultrasound in predicting histological findings can be assessed
(Gluckman et aL, 1993).
Computed tomography and Magnetic resonance are recognized
as generally the best methods of investigations, in fact CT has the
disadvantages of low specificity, use of intravenous contrast,
radiation exposure, and the most important its high costs especially
when it is used as a tool of screening, similarly MRI is costly and of
limited availability (Baatenburg et aL, 1989).
Ultasound IS a relatively inexpensive widely available
noninvasive medthod of investigation. Although there is extensive
documentation on the use of ultrasound in abdominal lesions it
appears to have been, the traditional and exclusive use of ultrasound
to separate cystic form solid tumours. High-resolution new
generation real-time machine allow recognition of secondary
changes in the structure of basically solid or cystic masses (Barki,
1992).
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Due to its widespread availability, sensitivity, accuracy and high
specificity when combined with ultrasound - guided fine needle
aspiration biopsy (U.S.G.F.N.A.B.), high resolution real time
ultrasonography can be used as a simple and inexpensive method for
pre-operative evaluation of neck diseases (Gritzmann, 1992).
The present study was undertaken to compare clinical,
ultrasound and surgical + (U.S. G. F. N. A. B.) findings proved by
histopathology.
In our study the ultrasound was superior in detection of different
types of thyroid swellings. For multinodular swelling, ultrasound
proved to have sensitivity 100% and accuracy 100% compared to
clinical examination that had sensitivity 28.57% and accuracy
28.57%, also ultrasound had nil false -ve cases (0) compared to
clinical examination which had high false
-ve cases (10 cases), these (10) cases that were detected by
ultrasound were diagnosed by clinical examination to have solitary
nodular swelling.
For solitary nodular swellings ultrasound had sensitivity
100% and accuracy 100% compared to clinical examination
that had sensitivity 28.57% and accuracy 28.57%, also ultrasound
had nil false +ve cases (0) compared to clinical examination
that had high false +ve cases (10 cases). For diffuse non nodular
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swellings both ultrasound and clinical examination had sensitivity
100% and accuracy 100%.
For detection of number of thyroid nodules ultrasound proved to
have sensitivity (100%) and accuracy (94.44%) compared to clinical
examination that had sensitivity 100% and accuracy 55.88%, also
ultrasound had nil false -ve (0) cases compared to clinical
examination that had high false. -ve cases (30), on the other hand
clinical examinatin had nil false +ve cases (0) but ultrasound had (4)
cases to be false +ve.
For submandibular gland swellings in our study, ultrasound
proved to have sensitivity 100% and accuracy 100% in detecting
submandibular gland swelling compared with clinical examination
that had sensitivity 100% and accuracy 73.33%, on the other hand
clinical examination had ahigh false +cases (8) compared with
ultrasound exmination (0) in detecting submandibular gland
swelling ,also there was significant difference between ultrasound
and clinical examination and between surgical and clinical
examination while there was no significant difference between
ultrasound and surgical examination
In detecting submandibular lymph nodes swellings ultrasound
had sensitivity 100% and accuracy 100% while clinical examination
had sensitivity 25% and accuracy 25% ,on the other hand clinical
examination had high false cases (6) compared with ultrasound (0) ,
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also there was significant difference between ultradound and clinical
examination and between (surgical+U.S.G.F.N.A.B) and clinical
examination while, there was no significant difference between
ultrasound and (surgical+ U. S. G. F. N. A.B) examination.
In detecting submandiblar fossa swelling ultrasound had
sensitivity 100% and accuracy 100%, while clinical examination
had sensitivity 0.0% and accuracy 0.0%, on the other hand clinical
examination had (2) cases false -ve while ultrasound had no cases of
false-ve (0), there was significant difference between ultrasound and
clinical examination and also between clinical and (surgical + U. S.
G. F. N. A. B.) while, there was no significant difference between
ultrasound and (surgical + U. S. G. F. N. A. B.) examination.
In parotid swellings due to parotiditis ultrasound had
sensitivity 100% and accuracy 100% while clinical examination had
sensitivity 100% and accuracy 100% but in parotid abscess
ultrasound had sensitivity 100% and accuracy 100% while clinical
examination had sensitivity (100%) and accuracy (100%).
In our study, ultrasound was suporior to clinical and x.ray film
in detecting submandibular gland stones, ultrasound had sensitivity
100% and accuracy 91.67% while clinical examination had
sensitivity 54.55% and accuracy 54.55% and x.ray had sensitivity
63.64% and accurcy 63.64%. On the other hand clinical and x.ray
examination had high false cases (10), (8) respectively compared
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with ultrasound which had (0) false -ve cases, also there was
significat difference between ultrasound and clinical; x.ray film
examination, while there wes no significant difference between
ultrasound and surgical examination, this revealed the high accuracy
and sensitivity of ultrasound in submandiular gland diseases
detection.
For lymph nodes study, in malignant nodes category palpation
detected 10 cases out of 14 cases to have palpable lymph nodes
while ultrasound detected all 14 cases to have lymph nodes, on the
other hand palpation detected (36) palpable lymph nodes while
ultrasound detected (77) lymph nodes, this proved significant
difference between the two results. In reactive nodes category
palpation detected 20 cases out of 32 cases to have palpable lymph
nodes, on the other hand ultrasound detected lymph nodes in 28
cases out of 32 cases, palpation detected 22 palpable lymph nodes
while ultrasound detected 62 nodes, this proved significant
difference between the two results.
In our study 80.5% of malignant nodes had a rounded shape and
19.5% of them had an oval shape on the other hand 80.6 of reactive
nodes had an oval shape arid 19.4% had a rounded shape. this
indicated, that malignant nodes has a tendency to be round while
reactive nodes has a tendency to be oval.
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In our study, according to echogenicity in the category of
malignant nodes, ultrasound revealed that (61.03%) of the nodes
were hypo- echoic while 38.46% were of different echogenicity
while in the category of reactive nodes there were (54.87%) of the
nodes to be hypo-echoic and 12.9% of different echogenicity.
According to the margin, in the malignant nodes category there
was 41.6% of regular margin and 58.4% of irregular margin, while
in the reactive nodes category there was 87.1% of regular margin
and 12.9% of irregular margin, this revealed that malignant nodes
seems to have irregular margin greatly while reative nodes seems to
have regular margin.
In our study the results obtained by ultrasound in the congenital
group revealed that ultrasound and clinical examination detected the
swellings by the same success, but it differs in the miscellaneous
group, in detecting lipomatous and sebaceous cyst swellings
ultrasound and clinical examination had the same sensitivity and
accuracy (100%).
Also in the cases of carotid body tumour and myosarcoma of
sternomastoid muscle ultrasound had sensitivity 100% and accuracy
100% while clinical examination had sensitivity (0.0%) and
accuracy (0.0%) .