title: The value of ultrasound with ultrasound-guided fine-needle aspiration biopsy compared to computed tomography in the detection of regional metastases in the clinically negative neck.
abstract: OBJECTIVE
  Head and neck oncologists have not reached consensus regarding the role of contemporary imaging techniques in the evaluation of the clinically negative neck in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to compare the accuracy of ultrasound with guided fine-needle aspiration biopsy (UGFNAB) and computed tomography (CT) in detecting lymph node metastasis in the clinically negative neck.
  
  
  METHODS
  Sixty-four neck sides of patients with HNSCC were examined preoperatively by ultrasound/UGFNAB and CT at one of five participating tertiary care medical centers. The findings were correlated with the results of histopathologic examination of the neck specimen.
  
  
  RESULTS
  Ultrasound with guided fine-needle aspiration biopsy was characterized by a sensitivity of 48%, specificity of 100%, and overall accuracy of 79%. Three cases had nondiagnostic aspirations using UGFNAB and were excluded. CT demonstrated a sensitivity of 54%, specificity of 92%, and overall accuracy of 77%. UGFNAB detected two additional metastases not visualized on CT, whereas CT detected no metastases not seen on UGFNAB. The results of UGFNAB were similar between the participating centers.
  
  
  CONCLUSIONS
  Approximately one half of the clinically occult nodal metastases in our patient group were identified by both CT and UGFNAB. Overall, UGFNAB and CT demonstrated comparable accuracy. The sensitivity of CT was slightly better than UGFNAB, but the latter remained characterized by a superior specificity. The results of CT and UGFNAB did not appear to be supplementary. The choice of imaging modality for staging of the clinically negative neck depends on tumor site, T-stage, and experience and preference of the head and neck oncologist. If CT is required for staging of the primary tumor, additional staging of the neck by UGFNAB does not provide significant additional value.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, University Hospital Leiden, The Netherlands.
authors.forename: R P
authors.initials: RP
authors.lastname: Takes
authors.forename: P
authors.initials: P
authors.lastname: Righi
authors.forename: C A
authors.initials: CA
authors.lastname: Meeuwis
authors.forename: J J
authors.initials: JJ
authors.lastname: Manni
authors.forename: P
authors.initials: P
authors.lastname: Knegt
authors.forename: H A
authors.initials: HA
authors.lastname: Marres
authors.forename: H A
authors.initials: HA
authors.lastname: Spoelstra
authors.forename: M F
authors.initials: MF
authors.lastname: de Boer
authors.forename: A G
authors.initials: AG
authors.lastname: van der Mey
authors.forename: I
authors.initials: I
authors.lastname: Bruaset
authors.forename: V
authors.initials: V
authors.lastname: Ball
authors.forename: E
authors.initials: E
authors.lastname: Weisberger
authors.forename: S
authors.initials: S
authors.lastname: Radpour
authors.forename: R H
authors.initials: RH
authors.lastname: Kruyt
authors.forename: F B
authors.initials: FB
authors.lastname: Joosten
authors.forename: J S
authors.initials: JS
authors.lastname: Laméris
authors.forename: J A
authors.initials: JA
authors.lastname: van Oostayen
authors.forename: K
authors.initials: K
authors.lastname: Kopecky
authors.forename: K
authors.initials: K
authors.lastname: Caldemeyer
authors.forename: S C
authors.initials: SC
authors.lastname: Henzen-Logmans
authors.forename: J M
authors.initials: JM
authors.lastname: Wiersma-van Tilburg
authors.forename: F T
authors.initials: FT
authors.lastname: Bosman
authors.forename: J H
authors.initials: JH
authors.lastname: van Krieken
authors.forename: J
authors.initials: J
authors.lastname: Hermans
authors.forename: R J
authors.initials: RJ
authors.lastname: Baatenburg de Jong
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D009333:Neck; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional