title: Sonographically guided aspiration cytology of neck nodes for selection of treatment and follow-up in patients with N0 head and neck cancer.
abstract: OBJECTIVE
  The management of the clinically negative neck (NO) remains controversial because the incidence of occult metastases is high and the prognostic difference between elective treatment and a "wait and see" approach remains unclear. This study was undertaken to assess the role of sonographically guided aspiration cytology for the selection of the initial-management strategy for the neck and for the early detection of neck metastases during follow-up of patients with NO.
  
  
  METHODS
  Seventy-seven clinically and cytologically confirmed NO patients, who underwent a transoral tumor excision and no neck treatment, were followed up for 1 to 4 years by both palpation and sonographically guided aspiration cytology.
  
  
  RESULTS
  Fourteen patients (18%) had recurrent neck tumor; 10 (71%) of these necks were salvaged. Of the 14 neck failures, six were detected before being palpable and nine were detected within 7 months. Eleven of the 19 aspirated tumor-positive nodes had a minimal diameter smaller than 1 cm, and all four patients who eventually died had lymph node metastases larger than 14 mm.
  
  
  CONCLUSIONS
  With sonographically guided aspiration cytology, the risk of missing occult metastases was 18%, which is less than expected after palpation only. Sonographically guided aspiration cytology is an effective technique for following up on the status of the neck after transoral tumor excision, and should be used at frequent intervals if no elective neck treatment is performed.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: van den Brekel
authors.forename: L C
authors.initials: LC
authors.lastname: Reitsma
authors.forename: J J
authors.initials: JJ
authors.lastname: Quak
authors.forename: L E
authors.initials: LE
authors.lastname: Smeele
authors.forename: J C
authors.initials: JC
authors.lastname: van der Linden
authors.forename: G B
authors.initials: GB
authors.lastname: Snow
authors.forename: J A
authors.initials: JA
authors.lastname: Castelijns
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D014463:Ultrasonography / Q000295:instrumentation*