DETECTION OF CERVICAL METASTASIS - A METAANALYSIS COMPARING COMPUTED-TOMOGRAPHY WITH PHYSICAL-EXAMINATION

Background: Despite extensive coverage in recent literature, controver sy continues with regard to the relative sensitivities of computed tom ography (CT) and physical examination (PE). Objective: To identify a s tatistically significant consensus. Data Sources: Initially, data were reviewed on 47 consecutive patients with head and neck cancer on whom a total of 53 neck dissections were performed. These data were combin ed with findings from a 15-year MEDLINE review of the English-language literature, including references. Study Selection: All publications t hat contained a direct comparison of CT with PE, with appropriate data availability, were included. Data Extraction : Multiple-observer inde pendent extraction was used. A total of 647 neck dissections were incl uded in the meta-analysis. The definition of metastasis varied minimal ly among studies as follows: (1) nodal size, greater than 10 to 15 mm; (2) multiplicity of 8- to 10-mm nodes; or (3) evidence of necrosis. N ecks were compared for positivity or negativity rather than for the ac tual nodal staging. In all cases, a final determination was made by re sults of histopathologic examination of surgical specimens. Data Synth eses: The results in this review favored CT over PE but were not stati stically significant by use of the Fisher exact test. A combination of the present study's data with those of the literature review yielded the following meta-analysis results: sensitivity, 83% (CT) vs 74% (PE) (P=.002); specificity, 83% (CT) vs 81% (PE) (P=.7); and accuracy, 83% (CT) vs 77% (PE) (P=.006). Overall, PE identified 75% of pathologic c ervical adenopathy; this detection rate increased to 91% with the addi tion of CT. The results of sensitivity analysis confirmed homogeneity across study designs. Conclusions: Computed tomography is a more sensi tive indicator of cervical metastasis than PE. More importantly, these diagnostic modalities were additive, with CT significantly enhancing the detection rates of PE alone. All patients who are at risk for cerv ical metastasis should have CT or equivalent radiographic imaging perf ormed prior to therapeutic intervention. Future studies correlating CT detection rates to the primary site and staging are needed before mor e specific conclusions can be drawn.