title: Initial staging of the neck in head and neck squamous cell carcinoma: a comparison of CT, PET/CT, and ultrasound-guided fine-needle aspiration cytology.
abstract: BACKGROUND
  The aim of this study was to compare imaging modalities for staging the neck in a prospective cohort of patients evaluated by CT, ultrasound with fine-needle aspiration cytology (FNAC), and [(18)F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/CT with the histologic evaluation of the neck dissection as the standard of reference.
  
  
  METHODS
  In all, 76 consecutive patients were prospectively enrolled.
  
  
  RESULTS
  Ultrasound-guided FNAC showed the highest level of agreement with histology for exact N classification. Ultrasound-guided FNAC showed the smallest percentage of overstaged patients, 7%, versus 16% with PET/CT, 13% with CT, and 13% with ultrasound. The rate of understaged patients was comparable between the imaging modalities. With regard to the endpoint N0 versus N+ there were no statistically significant differences to be found.
  
  
  CONCLUSIONS
  Ultrasound-guided FNAC seems to correlate best with histologic staging compared with PET/CT and CT. None of the modality is reliable enough to replace elective neck treatment in cN0 necks.
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland. sandro.stoeckli@kssg.ch
authors: Sandro J
authors: SJ
authors: Stoeckli
authors: Stephan K
authors: SK
authors: Haerle
authors: Klaus
authors: K
authors: Strobel
authors: Sarah R
authors: SR
authors: Haile
authors: Thomas F
authors: TF
authors: Hany
authors: Bernhard
authors: B
authors: Schuknecht