Abstract
The search for a single non-invasive highly accurate diagnostic modality for identification of cervical metastasis in head and neck squamous cell carcinoma (HNSCC) is yet to bear fruit. Thirty proven cases of HNSCC with no palpable neck nodes were selected, requiring surgery for the primary tumour. Detailed clinical evaluation and contrast enhanced computed tomography (CECT) scans were done. Patients underwent elective neck dissection along with surgery for the primary tumour. Specimens were sent for histopathological examination (HPE), considered gold standard. Results of CECT were compared with HPE. Clinical examination had a NPV of 80 % and CECT had a sensitivity, specificity, PPV, NPV, and accuracy of 83, 75, 45.5, 94.7, and 76.7 % respectively. A CECT may be added to the initial assessment of a patient of HNSCC, allowing for earlier diagnosis of nodal metastasis that may allow for a better chance at survival.
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References
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) GLOBOCAN 2008 v2.0, Cancer incidence and mortality worldwide: IARC Cancer Base No. 10 [Internet], International Agency for Research on Cancer, Lyon, France. http://globocan.iarc.fr. Accessed October 2014
van den Brekel MWM, Castelijns JA, Snow GB (1998) Diagnostic evaluation of the neck. Otolaryngol Clin N Am 31(4):601–620
Medina JE, Weisman RA (1998) Preface. Otolaryngol Clin N Am 31(4):9–10
Paleri V, Watkinson JC (2012) Metastatic neck disease. In: Watkinson JC, Gilbert RW (eds) Stell and Maran’s textbook of head and neck surgery and oncology, 5th edn. Hodder Arnold, London, pp 661–689
Ali S, Tiwari RM, Snow GB (1985) False positive and false negative neck nodes. Head Neck 8(2):78–82
Sako K, Pradier RN, Marchetta FC, Pickren JW (1964) Fallibility of palpation in the diagnosis of metastases to cervical nodes. Surg Gynecol Obstet 118:989–990
Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley/Blackwell, Oxford
Kademani D, Bell RB, Bagheri S, Holmgren E, Dierks E, Potter B, Homer L (2005) Prognostic factors in intraoral squamous cell carcinoma: the influence of histologic grade. J Oral Maxillofac Surg 63:1599–1605
To EW, Tsang WM, Cheng J, Lai E, Pang P, Ahuja AT, Ying M (2003) Is neck ultrasound necessary for early stage oral tongue carcinoma with clinically N0 neck? Dentomaxillofac Radiol 32:156–159
Knappe M, Louw M, Gregor RT (2000) Ultrasonography-guided fine-needle aspiration for the assessment of cervical metastases. Arch Otolaryngol Head Neck Surg 126:1091–1096
Haberal I, Celik H, Göçmen H, Akmansu H, Yörük M, Ozeri C (2004) Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography. Otolaryngol Head Neck Surg 130:197–201
Stevens MH, Harnsberger HR, Mancuso AA, Davis RK, Johnson LP, Parkin JL (1985) Computed tomography of cervical lymph nodes. Staging and management of head and neck cancer. Arch Otolaryngol 111(11):735–739
Feinmesser R, Freeman JL, Noyek AM, Birt BD (1987) Metastatic neck disease: a clinical/radiographic/pathologic correlative study. Arch Otolaryngol Head Neck Surg 113(12):1307–1310
Merritt RM, Williams MF, James TH, Porubsky ES (1997) Detection of cervical metastasis: a meta-analysis comparing computed tomography with physical examination. Arch Otolaryngol Head Neck Surg 123:149–152
Anand N, Chaudhary N, Mittal MK, Prasad R (2007) Comparison of the efficacy of clinical examination, ultrasound neck and computed tomography in detection and staging of cervical lymph node metastasis in head and neck cancers. Indian J Otolaryngol Head Neck Surg 59(1):19–23
Unzurrunzaga EI, Angulo MG, Arechaga LV, Larracoechea UA (2011) Bedialauneta JRI Predictive ability of the CT to evaluate cervical lymph nodes in head and neck tumours. Acta Otorhinolaryngol Esp 62:443–447
Rottey S, Petrovic M, Bauters W, Merville K, Vanherreweghe E, Bonte K, Van Belle S, Vermeersch H (2006) Evaluation of metastatic lymph nodes in head and neck cancer: a comparative study between palpation, ultrasonography, ultrasound-guided fine needle aspiration cytology and computed tomography. Acta Clin Belg 61(5):236–241
Watkinson JC, Todd CE, Paskin L, Rankin S, Palmer T, Shaheen OH, Clarke SE (1991) Metastatic carcinoma in the neck: a clinical, radiological, scintigraphic and pathological study. Clin Otolaryngol Allied Sci 16(2):187–192
Moreau P, Goffarty Y, Collignon J (1990) Computed tomography of metastatic cervical lymph nodes: a clinical, computed tomographic, pathologic correlative study. Arch Otolaryngol Head Neck Surg 116(10):1190–1193
Thakur JS, Sharma ML, Mohan C, Mohindroo NK, Kaushik NK (2007) Clinicopathological and radiological evaluation of cervical lymph node metastasis in head and neck malignancies. Indian J Otolaryngol Head Neck Surg 59(4):327–331
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The above research has not been funded by any organization, and all authors have declared that they have no conflict of interest.
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Bhargava, E.K., Rathore, P.K., Raj, A. et al. Diagnostic Efficacy of Computed Tomography in Detecting Cervical Metastases in Clinically N0 Head and Neck Squamous Cell Carcinoma. Indian J Otolaryngol Head Neck Surg 68, 25–29 (2016). https://doi.org/10.1007/s12070-015-0837-4
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DOI: https://doi.org/10.1007/s12070-015-0837-4