Cervical staging by head and neck surgeon-performed ultrasound and FNAC in N+ head and neck cancer

Cervical staging by head and neck surgeon-performed ultrasound and FNAC in N+ head and neck cancer. Problem/ objective: To investigate the diagnostic value of ultrasound (US) combined with US-guided fine needle aspiration cytology (FNAC) when performed by head and neck surgeons in N-positive (N+) head and neck cancer patients.

Methodology: Eighty-five head and neck cancer patients were retrospectively analyzed for malignant lymph node detection by preoperative cervical US and computed tomography (CT) and the results were compared to the gold standard, postoperative histopathology of neck dissection specimens. US alone, US combined with FNAC and CT were compared in a subgroup of 55 patients who were histologically N+.

Results: Sensitivity, specificity and accuracy for nodal metastasis detection were 92%, 74%, and 86% for US compared to 83%, 82% and 83% for CT, respectively. In patients who were N+, sensitivity was 100% for US, 84% for US-guided FNAC, and 88% for CT. The correct N staging rate compared to histopathology was 60% for US, 60% for CT, and 50% for US-guided FNAC.

Conclusion: US performed by head and neck surgeons is a feasible and sensitive diagnostic tool for detecting cervical metastasis, with superior efficacy versus CT. In patients who were N+, combined US-guided FNAC of suspect lymph nodes considerably lowers the value of US because of the risk of false negative cytology. In patients who were clinically N0, however, a review of literature shows that the value of US is enhanced by combined US-guided FNAC of sentinel lymph nodes. A protocol for the clinical use of cervical US and US-guided FNAC for cervical staging is proposed.