title: Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup.
abstract: BACKGROUND
  Preoperative lymph node screening of all neck compartments is favored by clinicians for the management of the neck. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate to 50%, and the presence of a metastatic node on both sides of the neck reduces the 5-year survival rate to 25%.
  
  
  METHODS
  This study compared the evaluation of lymph node metastases by ultrasonography (USG) and computed tomography (CT) in patients with squamous cell cancer of the head and neck region.
  
  
  RESULTS
  Five hundred and eighty-four patients with squamous cell cancer of the head and neck were prospectively evaluated for the presence of cervical lymph node metastases. All patients underwent clinical examination (palpation), USG and CT imaging. Neck dissection was performed in all the patients, and the results of the preoperative evaluation were correlated with the surgical and histopathological findings. Metastases in neck nodes were identified in 148 patients by histopathological examination. Doppler USG correctly identified 136 node-positive patients (n = 148; sensitivity 91.8%, specificity 97%). CT imaging correctly identified 122 patients with metastatic lymph nodes (n = 148; sensitivity 83%, specificity 93%). Positive predictive values of USG and CT imaging were 95.6% and 91.3%, respectively, whereas the negative predictive values of these two imaging studies were 95.4% and 89.6%, respectively.
  
  
  CONCLUSIONS
  The accuracy and sensitivity of USG in detection of cervical lymph node metastases make it a potentially promising and cheap preoperative tool for staging neck node metastases and optimizing the treatment plan for surgeons, especially in countries such as India.
authors.affiliation: Department of Surgical Oncolgy, Chittaranjan National Cancer Institute, 37 S P Mukherjee Road, Kolkata 26, India. aashob@gmail.com
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ashraf
authors.forename: Jaydip
authors.initials: J
authors.lastname: Biswas
authors.forename: Jayesh
authors.initials: J
authors.lastname: Jha
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nayak
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.forename: Suparna
authors.initials: S
authors.lastname: Majumdar
authors.forename: Anup
authors.initials: A
authors.lastname: Bhowmick
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Dam
mesh_terms: D000328:Adult; D000368:Aged; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007194:India; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging* / Q000473:pathology; D037981:Neck Dissection; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography