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.

STUDY

DESIGN

In head and neck cancer patients, diagnosis of metastatic lymph nodes of the neck is essential for treatment planning and prognosis assessment. In a retrospective study, we compared palpation, ultrasonography, ultrasound-guided fine needle aspiration and computed tomography in patients with head and neck cancer.

METHODS

Results of palpation, ultrasonography and computed tomography were available in 78 out of 110 patients diagnosed with head and neck cancer. Ultrasound-guided fine needle aspiration cytology was performed in 26 of these patients. Patients with suspected lymph node(s) observed in one or more techniques underwent neck dissection.

RESULTS

Twenty seven patients underwent neck dissection, studying 150 lymph node regions. The sensitivity, specificity, positive predictive value, negative predictive value and efficacy were calculated for palpation (48.7%, 95.5%, 79.2%, 84.1%, 83.3% respectively), ultrasonography (65.8%, 83.0%, 56.8%, 87.7%, 78.7% respectively), ultrasound-guided fine needle aspiration cytology (86.7%, 87.5%, 81.3%, 91.3%, 87.2% respectively) and computed tomography (52.5%, 83.6%, 53.9%, 82.9%, 75.3% respectively).

CONCLUSIONS

In the assessment of lymph node metastases of the neck in patients with primary head and neck cancer, we found a high specificity for palpation of the neck and an acceptable efficacy for both ultrasonography and computed tomography being comparable between the two methods. Efficacy of ultrasound-guided fine needle aspiration cytology was high approaching the value of 90%.