THE VALUE OF ULTRASOUND WITH ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATIONBIOPSY COMPARED TO COMPUTED-TOMOGRAPHY IN THE DETECTION OF REGIONAL METASTASES IN THE CLINICALLY NEGATIVE NECK

Purpose: Head and neck oncologists have not reached consensus regardin g the role of contemporary imaging techniques in the evaluation of the clinically negative neck in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to compare th e accuracy of ultrasound with guided fine-needle aspiration biopsy (UG FNAB) and computed tomography (CT) in detecting lymph node metastasis in the clinically negative neck. Methods and Materials: Sixty-four nec k sides of patients with HNSCC were examined preoperatively by ultraso und/UGFNAB and CT al one of five participating tertiary care medical c enters. The findings were correlated with the results of histopatholog ic examination of the neck specimen. Results: Ultrasound with guided f ine-needle aspiration biopsy was characterized by a sensitivity of 48% , specificity of 100%, and overall accuracy of 79%. Three cases had no ndiagnostic aspirations using UGFNAB and were excluded. CT demonstrate d a sensitivity of 54%, specificity of 92%, and overall accuracy of 77 %. UGFNAB detected two additional metastases not visualized on CT, whe reas CT detected no metastases not seen on UGFNAB. The results of UGFN AB were similar between the participating centers. Conclusions: Approx imately one half of the clinically occult nodal metastases in our pati ent group were identified by both CT and UGFNAB. Overall, UGFNAB and C T demonstrated comparable accuracy. The sensitivity of CT was slightly better than UGFNAB, but the latter remained characterized by a superi or specificity. The results of CT and UGFNAB did not appear to be supp lementary. The choice of imaging modality for staging of the clinicall y negative neck depends on tumor site, T-stage, and experience and pre ference of the head and neck oncologist. If CT is required for staging of the primary tumor, additional staging of the neck by UGFNAB does n ot provide significant additional value. (C) 1998 Elsevier Science Inc .