Sonographically guided aspiration cytology of neck nodes for selection of treatment and follow-up in patients with N0 head and neck cancer

BACKGROUND AND PURPOSE: The management of the clinically negative neck (NO) remains controversial because the incidence of occult metastases is high a nd the prognostic difference between elective treatment and a "wait and see " approach remains unclear. This study was undertaken to assess the role of sonographically guided aspiration cytology for the selection of the initia l-management strategy for the neck and for the early detection of neck meta stases during follow-up of patients with NO. METHODS: Seventy-seven clinically and cytologically confirmed NO patients, who underwent a transoral tumor excision and no neck treatment, were follow ed up for 1 to 4 years by both palpation and sonographically guided aspirat ion cytology, RESULTS: Fourteen patients (18%) had recurrent neck tumor; 10 (71%) of thes e necks were salvaged, Of the 14 neck failures, six were detected before be ing palpable and nine were detected within 7 months. Eleven of the 19 aspir ated tumor-positive nodes had a minimal diameter smaller than 1 cm, and all four patients who eventually died had lymph node metastases larger than 14 mm, CONCLUSION: With sonographically guided aspiration cytology, the risk of mi ssing occult metastases was 18%, which is less than expected after palpatio n only, Sonographically guided aspiration cytology is an effective techniqu e for following up on the status of the neck after transoral tumor excision , and should be used at frequent intervals if no elective neck treatment is performed.