Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI.
BACKGROUND
The choice of treatment in patients with oral malignancies depends on accurate pretreatment staging and particularly the detection of lymph node involvement. Therefore staging of the neck should be as accurate as possible.


METHODS
One hundred and six patients with histologically proven squamous cell carcinoma of the oral cavity.


METHODS
In a prospective study, PET using fluoro-desoxy-glucose (18F-FDG), ultrasound, CT and MRI of head and neck were compared with the postoperative histologic tissue evaluation. Two thousand one hundred and ninety-six neck lymph nodes of 106 patients were investigated. In all patients the tumour was resected and a lymph node dissection was performed.


RESULTS
The diagnostic procedures showed the following results when compared with the histological findings: PET: sensitivity 70%, specificity 82%, accuracy 75%; Ultrasound: 84%, 68%, 76%; CT: 66%, 74%, 70%; MRI: 64%, 69% 66%. Thus PET showed the highest specificity while ultrasound had the highest sensitivity compared with the other staging procedures. A nonsignificant correlation was found between the size of a lymph node metastasis and the ability to detect it. In 10 patients, second primary tumours or distant metastases were detected by PET only.


CONCLUSIONS
Due to the high number of small lymph node metastases from oral cavity carcinoma, the non-invasive neck staging methods are limited to a maximum accuracy of 76%. Elective neck treatment should be mandatory for all patients with squamous cell carcinoma of the oral cavity.
Stuckensen
T
T
Department of Maxillofacial Plastic Surgery, Johann Wolfgang Goethe University Medical Centre, Frankfurt am Main, Germany.
Kovács
A F
AF
Adams
S
S
Baum
R P
RP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D003952:Diagnostic Imaging; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18