title: Observer error in the assessment of nodal disease in head and neck cancer.
abstract: BACKGROUND
  There is no previously published information on clinicians' abilities to accurately differentiate between different stages of node positive disease in head and neck cancer.
  
  
  METHODS
  Forty-two surgeons examined standardized nodes in a model neck and estimated nodal size. Each recorded their confidence in their ability to perform the task using a visual analogue scale. Reference nodes of known size were provided for comparison during a second examination of each node. The study was repeated after 1 month.
  
  
  RESULTS
  Accuracy was poor and was not dependent on experience or confidence. There was a tendency to underestimate the size of smaller nodes. Estimates were strongly influenced by volume independent of largest diameter (p <.001). Reference nodes aided accuracy (p =.031). Subjects were not consistent on repeated testing (p <.001).
  
  
  CONCLUSIONS
  Both trainees and specialists are poor at accurately staging nodal disease using palpation alone.
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL United Kingdom.
authors.forename: D J
authors.initials: DJ
authors.lastname: Alderson
authors.forename: T M
authors.initials: TM
authors.lastname: Jones
authors.forename: S J
authors.initials: SJ
authors.lastname: White
authors.forename: N J
authors.initials: NJ
authors.lastname: Roland
mesh_terms: D002983:Clinical Competence; D003937:Diagnosis, Differential; D006258:Head and Neck Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D015588:Observer Variation; D010173:Palpation; D012107:Research Design