title: Ultrasound-guided fine needle aspiration cytology in the assessment of cervical metastasis in patients undergoing elective neck dissection.
abstract: BACKGROUND
  In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients' survival.
  
  
  OBJECTIVE
  To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis.
  
  
  METHODS
  Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique.
  
  
  RESULTS
  Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests.
  
  
  CONCLUSIONS
  In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection.
authors.affiliation: Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Payman
authors.initials: P
authors.lastname: Dabirmoghaddam
authors.affiliation: Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shervin
authors.initials: S
authors.lastname: Sharifkashany
authors.affiliation: Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Mashali
keywords: Cancer of Head and Neck; Lymph Nodes; Neoplasm Metastasis; Palpation; Ultrasonography