title: Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma.
abstract: Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and is an important prognostic factor. The currently available imaging techniques for assessment of the neck have limitations in accuracy; thus, elective neck dissection has remained the usual choice of management of the clinically N0 neck (cN0) for tumors with significant (≥20%) incidence of occult regional metastasis. As a consequence, the majority of patients without regional metastasis will undergo unnecessary treatment. The purpose of this review was to discuss new developments in techniques that potentially improve the accuracy of the assessment of the neck in patients with HNSCC. Although imaging has improved in the last decades, a limitation common to all imaging techniques is a lack of sensitivity for small tumor deposits. Therefore, complementary to improvements in imaging techniques, developments in more invasive diagnostic procedures, such as sentinel node biopsy (SNB) will add to the accuracy of diagnostic algorithms for the staging of the neck.
authors: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors: Remco
authors: R
authors: de Bree
authors: Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Robert P
authors: RP
authors: Takes
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Jonas A
authors: JA
authors: Castelijns
authors: Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors: Jesus E
authors: JE
authors: Medina
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland.
authors: Sandro J
authors: SJ
authors: Stoeckli
authors: Department of Radiology, University of Florida College of Medicine, Gainesville, Florida.
authors: Anthony A
authors: AA
authors: Mancuso
authors: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Jennifer L
authors: JL
authors: Hunt
authors: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.|Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.
authors: Juan P
authors: JP
authors: Rodrigo
authors: Oral Pathology, School of Dentistry, University of Liverpool, Liverpool, United Kingdom.
authors: Asterios
authors: A
authors: Triantafyllou
authors: Department of Otolaryngology-Head and Neck Surgery, University of Marburg, Marburg, Germany.
authors: Afshin
authors: A
authors: Teymoortash
authors: Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida.
authors: Francisco J
authors: FJ
authors: Civantos
authors: University of Udine School of Medicine, Udine, Italy.
authors: Alessandra
authors: A
authors: Rinaldo
authors: Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona.
authors: Karen T
authors: KT
authors: Pitman
authors: Department of Head and Neck Surgery, Head and Neck Oncology Program, St. Luc University Hospital and Cancer Center, Brussels, Belgium.
authors: Marc
authors: M
authors: Hamoir
authors: Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
authors: K Thomas
authors: KT
authors: Robbins
authors: Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors: Carl E
authors: CE
authors: Silver
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Otto S
authors: OS
authors: Hoekstra
authors: University of Udine School of Medicine, Udine, Italy.
authors: Alfio
authors: A
authors: Ferlito
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D018084:Ultrasonography, Interventional
keywords: diagnostic techniques; head and neck; lymph node metastasis; occult; squamous cell carcinoma