title: Relative value of ultrasound, computed tomography and positron emission tomography imaging in the clinically node-negative neck in oral cancer.
abstract: OBJECTIVE
  To determine the most accurate noninvasive imaging modality for occult metastasis in clinically node-negative necks in oral squamous cell carcinoma from a granulomatous disease endemic region.
  
  
  METHODS
  Prospective, observational study comparing ultrasound (US), contrast enhanced computed tomography (CECT) and positron emission tomography-computed tomography (PET-CT). Level wise assessment of neck nodes with each imaging modality was performed and compared with final histopathology.
  
  
  RESULTS
  Eighty-five necks were evaluated in 70 patients. Sensitivity, specificity and accuracy of the three modalities were 78.9, 68.75 and 73.25% for US, 73.6, 85.4 and 80.2% for CECT, and 81.5, 54.1 and 66.2% for PET-CT, respectively. CECT performed better than US and PET-CT scan particularly in levels IB and II (accuracy of 81.4 and 88.3% for CECT, 73.25 and 79.1% for US, and 68.6 and 68.6% for PET-CT scan, respectively). Concordance with histology was best with CECT (κ = 0.615) followed by US (κ = 0.461) and PET-CT (κ = 0.337).
  
  
  CONCLUSIONS
  The quest for the most accurate imaging modality in clinically node-negative necks continues. US alone is inadequate. While PET-CT may not be a specific imaging modality in detecting occult cervical nodal metastasis in endemic regions of chronic granulomatous diseases, the performance of PET CECT in this setting remains to be evaluated. CECT scan, routinely used in imaging for primary disease, is fairly accurate in detecting nodal metastasis. However, in early oral cancers that are generally treated without any imaging for the primary tumor, management of the neck will largely depend on clinical judgment.
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: Devendra
authors.initials: D
authors.lastname: Chaukar
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: Mitali
authors.initials: M
authors.lastname: Dandekar
authors.affiliation: Department of Pathology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Shubhada
authors.initials: S
authors.lastname: Kane
authors.affiliation: Department of Radiology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Supreeta
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of Nuclear Imaging, Tata Memorial Hospital, Mumbai, India.
authors.forename: Nilendu
authors.initials: N
authors.lastname: Purandare
authors.affiliation: Department of Nuclear Imaging, Tata Memorial Hospital, Mumbai, India.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Rangarajan
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: Anuja
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: Prathamesh
authors.initials: P
authors.lastname: Pai
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chaturvedi
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: Anil
authors.initials: A
authors.lastname: D'Cruz
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media / Q000737:chemistry; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D011446:Prospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: diagnostic imaging; granulomatous disease; neck metastasis; oral cancer; positron emission tomography