title: Radiological imaging of the neck for initial decision-making in oral squamous cell carcinomas--a questionnaire survey in the Nordic countries.
abstract: BACKGROUND
  Fast and accurate work-up is crucial to ensure the best possible treatment and prognosis for patients with head and neck cancer. The presence or absence of neck lymph node metastases is important for the prognosis and the choice of treatment. Clinical lymph node (N)-staging is done by palpation and diagnostic imaging of the neck. We investigated the current practice of the initial radiological work-up of patients with oral squamous cell carcinomas (OSCC) in the Nordic countries.
  
  
  METHODS
  A questionnaire regarding the availability and use of guidelines and imaging modalities for radiological N-staging in OSCC was distributed to 21 Head and Neck centres in Denmark (n = 4), Finland (n = 5), Iceland (n = 1), Norway (n = 4) and Sweden (n = 7). We also asked for a description of the radiological criteria for determining the lymph nodes as clinical positive (cN+) or negative (cN0).
  
  
  RESULTS
  All 21 Head and Neck centres responded to the questionnaire. Denmark and Finland have national guidelines, while Norway and Sweden have local or regional guidelines. Seventeen of the 19 centres with available guidelines recommended computed tomography (CT) of the cN0 neck. The waiting time may influence the imaging modalities used. Lymph node size was the most commonly used criteria for radiological cN+, but the cut-off measures vary from 0.8 to 2.0 cm.
  
  
  CONCLUSIONS
  Overall, CT is the most commonly recommended and used imaging modality for OSCC. Despite availability of national guidelines the type and number of radiological examinations vary between centres within a country, but the implementation of a fast-track programme may facilitate fast access to imaging. The absence of uniform criteria for determining the lymph nodes of the neck as cN+ complicates the comparison of the accuracy of the imaging modalities. Well-defined radiological strategies and criteria are needed to optimise the radiological work-up in OSCC.
authors.affiliation: Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. rna@dadlnet.dk
authors.forename: Rikke
authors.initials: R
authors.lastname: Norling
authors.forename: Cai
authors.initials: C
authors.lastname: Grau
authors.forename: Michael B
authors.initials: MB
authors.lastname: Nielsen
authors.forename: Preben
authors.initials: P
authors.lastname: Homøe
authors.forename: Jens A
authors.initials: JA
authors.lastname: Sørensen
authors.forename: Karin
authors.initials: K
authors.lastname: Lambertsen
authors.forename: Troels
authors.initials: T
authors.lastname: Bundgaard
authors.forename: Antti
authors.initials: A
authors.lastname: Mäkitie
authors.forename: Reidar
authors.initials: R
authors.lastname: Grénman
authors.forename: Jussi
authors.initials: J
authors.lastname: Larenne
authors.forename: Petri
authors.initials: P
authors.lastname: Koivunen
authors.forename: Jukka
authors.initials: J
authors.lastname: Virtaniemi
authors.forename: Arnar
authors.initials: A
authors.lastname: Gudjonsson
authors.forename: Olav
authors.initials: O
authors.lastname: Jetlund
authors.forename: Helmut
authors.initials: H
authors.lastname: Abendstein
authors.forename: Oddveig
authors.initials: O
authors.lastname: Rikardsen
authors.forename: Stein
authors.initials: S
authors.lastname: Lybak
authors.forename: Johan
authors.initials: J
authors.lastname: Wennerberg
authors.forename: Anders
authors.initials: A
authors.lastname: Högmo
authors.forename: Göran
authors.initials: G
authors.lastname: Laurell
authors.forename: Anders
authors.initials: A
authors.lastname: Westerborn
authors.forename: Eva
authors.initials: E
authors.lastname: Hammerlid
authors.forename: Wieslaw
authors.initials: W
authors.lastname: Tytor
authors.forename: Lena
authors.initials: L
authors.lastname: Cederblad
authors.forename: Christian
authors.initials: C
authors.lastname: von Buchwald
mesh_terms: D003657:Decision Making; D003952:Diagnostic Imaging; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D006801:Humans; D008207:Lymphatic Metastasis; D009333:Neck / Q000000981:diagnostic imaging / Q000473:pathology*; D037981:Neck Dissection; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011859:Radiography; D011877:Radionuclide Imaging; D011795:Surveys and Questionnaires