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PubMed1999

Manipulative physiotherapists can reliably palpate nominated lumbar spinal levels.

Palpating a nominated spinal level is a prerequisite to more complex tasks such as palpating the level most likely to be the source of the patient's symptoms. The aim of this study was to investigate the reliability of physiotherapists with a post-graduate qualification in manipulation (manipulative physiotherapists) in palpating the lumbar spines of patients in a clinical setting. Three pairs of manipulative physiotherapists palpated the randomly-nominated lumbar spinal levels of 20 patients presenting to their practices for treatment of low-back pain. Each therapist marked the skin overlying the spinous process of the nominated spinal level with an ultraviolet pen and these marks were transcribed onto transparencies for analysis. The therapists obtained an overall weighted kappa of 0.92 indicating almost perfect agreement for locating the nominated spinal level. The results of this study indicate that manipulative physiotherapists can reliably palpate nominated lumbar spinal levels, suggesting further training in spinal therapy enhances the palpatory skills of physiotherapists in palpating nominated lumbar spinal levels.

Analysis of Variance↗
PubMed1996

Postexercise heart rates and pulse palpation as a means of determining exercising intensity in an aerobic dance class.

OBJECTIVE: To establish the accuracy of the traditional method of measuring the intensity of exercise in aerobic dance classes, that is, intermittent pulse palpation performed during a brief cessation of activity. METHODS: A short wave telemetry system was used to record heart rates during a class in a group of 12 healthy women aged 26 (SD 6) years. Subjects palpated their pulses for 10 s following high and low intensity exercise [78(8)% and 69(9)% of mean predicted maximum heart rate respectively]. Recorded exercising heart rates, averaged over 60 s preceding pulse palpation [ExHR(rec)], were compared with the recorded postexercise heart rates averaged over the 10 s palpation period [PostExHR(rec)] and with the palpated counts (PalpHR). Differences were assessed using Student's t test and Wilcoxon signed rank test. RESULTS: Differences between ExHR(rec) and PostExHR(rec) following high and low intensity exercise [3(6) beats.min-1 and 5(7) beats.min-1 respectively] were not significant. However, the wide variation between subjects means that a postexercise heart rate is unreliable as a measure of individual exercise intensity. PalpHR was significantly lower than ExHR(rec) (P < 0.01). Every individually palpated count underestimated the exercising heart rate (range 9 to 95 beats.min-1). CONCLUSIONS: While postexercise heart rate adequately represents the exercise heart rate for a group, the individual variation is too wide for this to be a useful measurement.

Adult↗
PubMed2005

Ultrasonography using simple diagnostic criteria vs palpation for the detection of regional lymph node metastases of melanoma.

OBJECTIVES: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma. DESIGN: Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation. SETTING: Dermatology and radiology departments of a university hospital. PATIENTS: A total of 160 new consecutive patients with stage I to stage III melanoma. INTERVENTION: Experienced operators independently performed 391 paired palpation and ultrasonographic examinations. MAIN OUTCOME MEASURES: Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious. RESULTS: Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval [95% CI], 29.6-53.5) and 76.9% (95% CI, 66.7%-87.2%) (P<.001) and specificity was 95.7% (95% CI, 93.5%-97.9%) and 98.4% (95% CI, 97.1%-99.8%) (P<.05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% [95% CI, 82.5-89.9]) (P<.05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings. CONCLUSION: Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.

Adult↗
PubMed1999

Gynecological examination and pregnancy diagnosis in small ruminants using bimanual palpation technique: a review.

A palpation technique using both hands was developed by the author and used for examination of internal reproductive organs, pregnancy diagnosis, and assessment of approximate stages of gestation in small ruminants. The study was conducted in 4 stages on 87 female goats and 30 slaughterhouse source ewes First, 20 doelings and 15 does with no recent history of insemination were examined by two hand method for palpability and structural integrity of internal reproductive organs. Next 52 goats (28 doelings and 24 does) were examined at 28 to 30 d post insemination for pregnancy. Among those diagnosed pregnant, 20 goats were examined at 15 d intervals to assess the palpable changes of pregnancy. Preslaughter palpation followed by post-slaughter verification of the findings were performed in 30 ewes. The two hand method was effective for palpating the reproductive tract in the nonpregnant goats irrespective of parity status. Gross palpation of the ovaries was possible in 83% of the goats. Of the 52 goats examined for pregnancy at 28 to 30 d, 29 (56%) had clear distension of uterus while 23 (44%) did not. The results were confirmed by kidding date or returning to service. Changes of the reproductive tract were monitored in 20 goats at biweekly intervals and the findings categorized by the stage of gestation. Post slaughter verification of preslaughter findings based on two handed palpation indicates that this technique can be used for early pregnancy diagnosis and assessment of the stage of gestation in goats and ewes.

Animals↗
PubMed2003

Palpation for muscular tenderness in the anterior chest wall: an observer reliability study.

OBJECTIVE: To asses the interobserver and intraobserver reliability (in terms of day-to-day and hour-to-hour reliability) of palpation for muscular tenderness in the anterior chest wall. DESIGN: A repeated measures designs was used. SETTING: Department of Nuclear Medicine, Odense University Hospital, Denmark. PARTICIPANTS: Two experienced chiropractors examined 29 patients and 27 subjects in the interobserver part, and 1 of the 2 chiropractors examined 14 patients and 15 subjects in the intraobserver studies. INTERVENTION: Palpation for muscular tenderness was done in 14 predetermined areas of the anterior chest wall with all subjects sitting. Each dimension was rated as absent or present for tenderness or pain for each location. All examinations were carried out according to a standard written procedure. RESULTS: Based on a pooled analysis of data from palpation of the anterior chest wall, we found kappa values of 0.22 to 0.31 for the interobserver reliability. For the intraobserver reliability, we found kappa values of 0.21 to 0.28 for the day-to-day reliability and 0.44 to 0.49 for the hour-to-hour reliability. CONCLUSION: Our results indicated great variations between experienced chiropractors palpating for intercostal tenderness or tenderness in the minor and major pectoral muscles in a population of patients with and without chest pain. This may hamper the ability of clinicians to diagnose and classify the musculoskeletal component of chest pain if based exclusively on palpation of the anterior chest wall.

Case-Control Studies↗
PubMed2001

Palpation of the lateral pterygoid region in TMD--where is the evidence?

OBJECTIVE: Palpation of the lower head of the lateral pterygoid muscle is included in many study protocols and examination schemes of the masticatory system. The aim of this investigation was to search the medical/dental literature to find evidence for the validity and reliability of this diagnostic procedure. METHODS: A systematic search was carried out using different electronic databases (Medline Ovid, PubMed, Cochrane Library, Embase, Current Contents Connect, Science Citation Index, Web of Science, Japana Centra Revuo Medicina), supplemented by handsearch in selected journals and by examination of the bibliographies of the identified articles. RESULTS VALIDITY: As far as the palpability of the inferior head of the lateral pterygoid muscle is concerned, five publications representing four studies could be identified. According to these investigations, the lateral pterygoid muscle is practically inaccessible for intraoral palpation due to topographical and anatomical reasons. Other anatomical structures, such as the superficial head of the medial pterygoid muscle, may be palpated instead in this region. Reliability: Determination of the palpability of the lateral pterygoid muscle is characterized by poor interexaminer agreement. Studies investigating the presence of pain in response to palpation of the lateral pterygoid area revealed a moderate intra- and interindividual reliability. Because of the tenderness of the lateral pterygoid region even among healthy subjects, positive findings may lead to wrong conclusions with regard to the need of treatment. CONCLUSIONS: Considering the lack of validity and reliability associated with the palpation of the lateral pterygoid area, this diagnostic procedure should be discarded.

Databases as Topic↗
PubMed2003

Diagnostic value of magnetic resonance imaging in Peyronie's disease--a comparison both with palpation and ultrasound in the evaluation of plaque formation.

OBJECTIVE: To compare the value of magnetic resonance imaging (MRI) with palpation and ultrasound in the evaluation of plaque formation in Peyronie's disease. METHODS: 57 patients underwent a standardized diagnostic procedure to evaluate plaque formation consisting of palpation and ultrasonography (7.5 MHz). MRI was performed during flaccidity and during erection induced by Prostaglandin E(1) including intravenous application of Gadolinium-diethylenetriaminepentaacetic acid (Gd-DPTA). RESULTS: With all methods, 93 plaques have been detected in 57 patients. 85 plaques (91.4%) have been evaluated by palpation alone. Using ultrasound, 52 of these 93 plaques (55.9%) were detectable. This is equivalent to 61.1% of the palpable plaques. MRI confirmed 58 of the palpated plaques (68.2%) and exposed 8 primarily not palpable plaques at the penile basis. MRI revealed more palpable plaques than ultrasound, but this finding was not significant (p = 0.083). By means of sonography, calcification was evident in 14 plaques. MRI failed in revealing any calcification. After application of Gd-DPTA, 5 of 57 patients (9%) demonstrated contrast enhancement indicating local inflammation. None of these patients reported on penile pain. CONCLUSIONS: Penile palpation in combination with ultrasound represents the method of choice to diagnose plaque formation in Peyronie's disease. MRI provides better information on plaque formation at the penile basis. Calcification can only be proven by ultrasound, not by MRI. There may be additional information by MRI about local inflammation. A prospective study comparing the histological and MRI findings should be performed to answer the question, if pain is really associated with inflammation.

Adult↗
PubMed1992

The role of inexperience in measuring tuberculin skin reaction (Mantoux test) by the pen or palpation technique.

We have shown previously that experienced readers can use the palpation or pen method for reading the Mantoux tuberculin skin test with accuracy. In order to investigate if the inexperienced reader can use both methods with the same degree of accuracy, we performed Mantoux tests in 539 healthy subjects, aged 20-57 years (mean 33 years), using the PPD-RT 23 in dose 2 I.U. (1/5000). In random order and a double-blind fashion, an experienced and an inexperienced reader measured the induration after 48 h by the palpation method initially and then by the pen method, without knowing the identity of the subject. Results of the study did not show any significant difference in any range of measurements by the two readers, using either the pen or palpation method (P greater than 0.1). A highly statistically significant linear relationship was found between the measurements by the pen method used by experienced and inexperienced readers (r = 0.823, P less than 0.0001) and between the palpation measurements by the two readers (r = 0.939, P less than 0.0001). We conclude that the effects of an inexperienced examiner in the measurement of of tuberculin skin induration are minimal. Inexperienced readers can use the pen method as accurately as the traditional palpation method.

Adult↗
PubMed2004

Inter- and intraexaminer reliability in palpation of the "primary respiratory mechanism" within the "cranial concept".

Inevitable subjectivity makes interexaminer reliability of manual assessment procedures a special matter of concern. The cranial concept (CC), one aspect of osteopathy, deals with very subtle changes that have to be palpated. One of the main principles of the CC is the primary respiratory mechanism (PRM), which is hypothesized to be a palpable physiological phenomenon that occurs in rhythmic cycles, called flexion- and extension-phase, which are independent from cardiac and respiratory rates. Palpation of the PRM is one of the first steps in assessment within the CC. An inter- and intraexaminer reliability study design for repeated measures was used in this study. Forty nine healthy subjects were palpated simultaneously twice, once at the head and once at the pelvis. PRM-frequency (f), the mean duration of the flexion phase and the mean ratio of flexion- to extension-phase were used as the main outcome measures. Inter- and intraexaminer reliability and correlations to the respiratory rates were analysed for all three parameters. Inter- as well as intraexaminer agreement could not be described beyond chance agreement, as the range within the 95% limits of agreement (e.g. for f=6.6 cycles/90 s) for all cases resembled the total range of values (e.g. for f=7 cycles/90 s) that were produced. A significant effect of the examiners' respiration was found for both examiners at the pelvis (P=0.004 for one examiner, P <0.0001 for the other examiner), and for one examiner only at the head (P=0.0017). No correlation could be found for the subjects' respiratory rates. In conclusion, PRM-rates could not be palpated reliably and under certain conditions were influenced by the examiners' respiratory rates. These results do not support the hypotheses behind the PRM. The role of PRM palpation for clinical decision making and the models explaining the PRM should therefore be rethought.

Adult↗
PubMed2001

Measuring leg-length discrepancy by the "iliac crest palpation and book correction" method: reliability and validity.

OBJECTIVE: To determine the reliability and validity of a clinical measurement of leg-length discrepancy (LLD), by using the iliac crest palpation and book correction (ICPBC) method. DESIGN: Intra- and interrater reliability and validity determinations. SETTING: Rehabilitation center. PARTICIPANTS: Thirty-four healthy subjects, none of whom had an apparent LLD, as determined by iliac crest palpation. INTERVENTIONS: We induced a simulated LLD (7-53 mm) for each subject. To measure the LLD, the examiner performed the ICPBC method by palpating the iliac crests and correcting identified differences with a book opened to the required number of pages. The thickness of the book correction was measured. MAIN OUTCOME MEASURES: Reliability LLD measurement (n = 20), by using the ICPBC method to measure the LLD; construct validity (n = 34), comparing ICPBC measurement with the extent of the induced LLD; and concurrent validity (n = 14), the difference in heights of the superior aspect of the femoral heads from standing radiographs. RESULTS: The intraclass correlation coefficients (ICCs) for the intrarater and interrater reliabilities were.98 and.91, respectively. The ICCs for the construct and concurrent validities were.62 and.76, respectively. The ICPBC method underestimated the induced LLD by a mean difference +/- standard deviation of 3.8 +/- 10.3mm (p =.055) and the radiologic measure by 5.1 +/- 8.6 mm (p =.043). CONCLUSIONS: The ICPBC technique for measuring LLD is highly reliable and moderately valid. When there is no history of pelvic deformity and the iliac crests can be readily palpated, we recommend using iliac crest palpation to detect LLD, and the book correction to quantify it.

Adult↗
PubMed1991

[Cervical lymph node metastasis: significance of computerized tomography and palpation. A histologically controlled comparison].

Palpation and CT are used before treatment, in addition to sonography, in patients with tumours in the head and neck for lymph node staging. The accuracy of CT in identifying lymph node metastases is 79% and in our clinical material is similar to the accuracy of palpation (81%). Sensitivity of CT (93%) is better than palpation (82%). Specificity of CT (65%) is less than that of palpation (82%). The high percentage of false positives from CT (35%) is due to enlargement of the lymph nodes resulting from sinus histiocytosis or follicular hyperplasia. CT is significantly superior to palpation in demonstrating the relationship of the lymph nodes to the surrounding tissues (vessels, muscles, bones).

Adult↗
PubMed1990

[Cervical lymph node metastases: a histologically controlled comparison of palpation, sonography and computed tomography].

Sonography and CT were used pre-operatively for lymph node staging in patients with head and neck malignancies. The accuracy of the imaging methods surpassed that of palpation (palpation 85%, CT 85%, sonography 90%). Sensitivity was significantly increased from 74% (palpation) to 84% (CT) and 90% (sonography), ie. there was a reduction in false negative findings. Size of lymph nodes was not closely correlated with metastatic involvement. Reactively enlarged lymph nodes were more easily defined by CT and sonography than by palpation. This reduced the specificity of sonography (90%) and of CT (86%) compared to palpation (94%).

Carcinoma, Squamous Cell↗
PubMed1985

Pregnancy diagnosis in the dog: a comparison between abdominal palpation and linear-array real-time echography.

This paper presents quantitative results of canine pregnancy diagnoses performed by abdominal palpation and/or linear-array real-time echography. Each animal was first palpated by an experienced clinician and then another investigator performed ultrasound scanning using a 3 MHz transducer. In other dogs echography was undertaken only when the result of abdominal palpation was negative or doubtful or when the owner requested ultrasound scanning. Using all tests performed between days 20 and 49 of pregnancy (day 0 = day of first mating or insemination), the results of abdominal palpation (n = 116) versus real-time scanning (n = 135) were: sensitivity: 89.0% v 92.9%; specificity: 93% v 96.0%; positive predictive value: 95.6% v 97.5%; negative predictive value: 83.3% v 88.9%. Results of ultrasound tests performed in 97 other dogs were: sensitivity: 92.4%; specificity: 97.7%; positive predictive value: 98.0% and negative predictive value: 91.4%. Almost identical figures were found when only the tests performed between days 25 and 35 of pregnancy were included. It was concluded that real-time ultrasound scanning is an accurate method for discriminating between pregnant and non-pregnant bitches; sensitivity and specificity of the abdominal palpation technique executed by an experienced clinician approach that of ultrasound scanning; small litter size and lack of knowledge of conception date are the main sources of false negative diagnoses.

Abdomen↗
PubMed1993

Repeatability of measurement of tenderness in the neck-shoulder region by a dolorimeter and manual palpation.

OBJECTIVE: The aim of this study was to test the repeatability of dolorimeter measurements in subjects with and without neck-shoulder symptoms and interobserver agreement in manual palpation. The second aim was to analyze how subjects, measures, and the order of attempt influenced the repeatability of pain threshold (PT) measurements. DESIGN: Repeated measurements in 100 female volunteers who were office workers. SETTING: Interobserver repeatability was tested by examining 60 female office employees twice during the same day, and intraobserver repeatability was tested by examining 40 female office employees at an interval of 2 days. PATIENTS: Their mean age was 38 (20-55) years; height was 163 (149-174) cm; and weight was 60 (44-115) kg. MAIN OUTCOME MEASURES: PT measurement by dolorimeter and manual palpation findings of four defined palpation points. RESULTS: The inter- and intraobserver repeatability coefficients of the dolorimeter varied from 0.87 to 0.65; they were lower in subjects with neck-shoulder symptoms (DS) than in subjects with no or occasional symptoms (NOS). The sensitivity and specificity of dolorimeter for neck-shoulder symptoms was poor. The interobserver repeatability of manual palpation at trigger areas of trapezius and levator muscles varied from 0.15 to 0.62. CONCLUSIONS: The repeatability of dolorimeter is good, but sensitivity and specificity for neck-shoulder symptoms are poor. The dolorimeter is a good device for measurement of cervicobrachial tenderness when the subject acts as his or her own control. The repeatability of manual palpation is poor.

Adult↗
PubMed1993

Manual palpation and pain threshold in female office employees with and without neck-shoulder symptoms.

OBJECTIVE: The aim of this study was to quantify myofascial tenderness by using manual palpation and the dolorimeter on female office employees with disturbing neck-shoulder symptoms (DS) and no or occasional neck-shoulder symptoms (NOS). The association among neck-shoulder symptoms, pain threshold, and age was also analyzed. DESIGN: The cross-sectional study of female office employees selected on a voluntary basis from two offices. SETTING: The manual palpation of neck-shoulder muscles was analyzed at 16 palpation points defined before the examination. The pain threshold (PT) was measured at four trigger areas of trapezius and levator muscles. PATIENTS: 160 female office employees with mean age 41 (21-60) years; height was 163 (149-178) cm; and weight was 62 (45-115) kg. MAIN OUTCOME MEASURES: Manual palpation findings of neck-shoulder muscles at 16 defined palpation points and PT measurement of trigger areas in trapezius and levator muscles by a dolorimeter. RESULTS: The mean number of tender points was 7.25 (SD, 4.5) in subjects with DS and 3.44 (SD, 3.8) in subjects with NOS; the difference was significant (p < 0.0001). Suboccipital and trapezius muscles were tender in most cases in both symptom groups. The PTs of trapezius and levator muscles were significantly lower in subjects with DS than in subjects with NOS (p < 0.0001-0.0005). The PT of the trapezius muscles in subjects > or = 39 years old with DS was significantly lower than in those with NOS (p < 0.0007-0.0402). The PT of subjects with DS was lower in subjects 39 years old and older than in younger subjects, while the PT in subjects with NOS was higher in older subjects than in younger ones; the differences were statistically nonsignificant. CONCLUSIONS: Suboccipital and trapezius muscles are often tender in subjects with DS and in those with NOS. The finding that the PT of the trapezius muscle in older subjects with DS decreases while the PT in subjects with NOS increases is interesting and needs further investigation.

Adult↗
PubMed1991

Palpation as a method for evaluating occlusal discrepancies.

In this study, 30 dentists were surveyed about their methods of palpating teeth for the evaluation of premature contacts. Thirty-eight dentists were then tested to determine their ability to discriminate degrees of prematurity using each of two different methods of palpation. The degree of digital pressure used by each dentist during palpation was also measured. The majority of dentists chose the same method for palpation: a single forefinger overlaying the facial surfaces of the central incisors being evaluated. In the discrimination test, the majority of dentists were able to identify reliably occlusal interference of greater than or equal to 50 microns regardless of the palpation method used.

Adult↗
PubMed1994

Plasma cortisol response in dairy cows to vaginoscopy, genital palpation per rectum and artificial insemination.

Response of plasma cortisol concentrations after vaginoscopic examination, palpation of the genital organs per rectum and artificial insemination were investigated in six Holstein-Friesian cows weighing between 510 to 620 kg. Blood samples were collected by indwelling jugular catheter. The experiment was begun at 09:00 hours on the day when cows came into estrus. Blood samples were collected from 30 minutes before to 60 minutes after each treatment at intervals of 5 to 10 minutes. Cows were initially blood-sampled for 90 minutes at the same intervals without giving any treatment and then were subjected to vaginoscopy for 1.5 minutes, palpation of the uterus and ovaries per rectum for 4 minutes and artificial insemination by the recto-vaginal method for 5 minutes. No significant increase in plasma cortisol was shown in cows in estrus following vaginoscopy. Palpation per rectum as well as artificial insemination caused a significant increase in plasma cortisol (P < 0.01) 5 to 10 minutes after the initiation of treatments in cows in estrus. There was a tendency for cows in the luteal phase to show higher plasma cortisol levels after the vaginoscopy than cows in estrus. Adrenal response to palpation per rectum in cows in the luteal phase was similar to that in cows in estrus. Thus, in cows in estrus, palpation per rectum as well as artificial insemination may be potential stressors for cows, causing an increase in plasma cortisol levels. However, the pathophysiological importance of the rise in plasma cortisol levels is not known.

Animals↗
PubMed2004

Metastases in supraclavicular lymph nodes in lung cancer: assessment with palpation, US, and CT.

PURPOSE: To compare ultrasonography (US), computed tomography (CT), and palpation for diagnosing supraclavicular lung cancer metastases and to assess the effect of proved metastases on TNM stage and diagnostic work-up. MATERIALS AND METHODS: One hundred seventeen consecutive patients (91 men and 26 women; mean age, 64.0 years) underwent palpation, US, and CT of supraclavicular regions and chest and upper abdominal CT. Fine-needle aspiration cytologic (FNAC) analysis was performed in patients with nodes with a short-axis diameter of 5 mm or greater; cytologic diagnosis was used as the standard of reference. Sensitivities of palpation, US, and CT were compared with McNemar testing. Relationship between size and palpability of nodes with metastasis was evaluated with logistic regression. RESULTS: Supraclavicular metastases were diagnosed cytologically in 30 (26%) of 117 patients: eight (31%) of 26 patients with small cell lung cancer (SCLC) and 22 (24%) of 91 patients with non-small cell lung cancer (NSCLC). Sensitivities of US (1.00; 30 of 30 patients) and CT (0.83; 25 of 30 patients) for detection of metastases were significantly higher (P <.001 and P =.001, respectively) than that of palpation (0.33; 10 of 30 patients). Palpable nodes with metastasis (mean diameter, 25.2 mm) were significantly larger than nonpalpable nodes with metastasis (mean diameter, 13.7 mm) (P =.002). To have a 50% chance of being palpable, nodes with metastasis had to have a diameter of at least 22.3 mm. TNM stage was changed in three of 91 patients with NSCLC, and further invasive diagnostic procedures were prevented in 11 of such patients because it was proved that nonpalpable nodes had metastases. CONCLUSION: Supraclavicular lung cancer metastases were cytologically proved in 26% of patients. Nodes with metastasis were only palpable when markedly enlarged. US tripled the sensitivity of palpation for detection of metastases. Results of US and US-guided FNAC analysis can change the work-up in patients with lung cancer.

Adult↗