Source: Arch Otolaryngol Head Neck Surg. 2000;126:1091-1096
Authors: Marco Knappe, MD et al.

Objective:
To assess the value of ultrasonography (US) combined with fine-needle aspiration (FNA) cytology for the investigation of lymph node metastases in patients with head and neck cancer.

Design:
Comparison of clinical examination (palpation) and preoperative US-FNA examination results of cervical nodes in a sample of patients with head and neck cancer. The histological features of the neck dissection specimens are used to validate these 2 variables.

Setting:
A head and neck oncology service in a tertiary referral hospital.

Patients:
A consecutive sample of 56 patients with head and neck squamous cell carcinoma, first seen between April 1, 1996, and July 30, 1998, who had neck dissections performed after the US-FNA examination.

Intervention:
Cervical US-FNA preoperatively, followed by elective or therapeutic radical modified or selective neck dissection.

Main Outcome Measures:
The histological examination results of subsequent neck dissection specimens are used to determine the sensitivity, specificity, and accuracy of US-FNA for individual nodes. Second, the results of node staging by clinical examination and US-FNA examination are compared.

Results:
The sensitivity was 89.2%; specificity, 98.1%; and accuracy, 94.5%. Correct node stages were obtained in 52 (93%) of the patients using US-FNA compared with 34 (61%) using palpation.

Conclusions:
Ultrasonography combined with FNA is a highly accurate technique for the investigation of cervical lymph node metastases. A more accurate diagnosis may result in more appropriate treatment, particularly in a setting with limited resources. Retropharyngeal nodes, micrometastases, and lymph nodes smaller than 4 mm are limitations of US-FNA. Ultrasonography combined with FNA is a useful technique for the staging of head and neck cancer.

Authors:
Marco Knappe, MD; Mercia Louw, MMed(AnatPath); R. Theo Gregor, FRCS, PhD

Authors’ affiliation:
From the Departments of Otorhinolaryngology/Head and Neck Surgery (Drs Knappe and Gregor) and Anatomical Pathology (Dr Louw), University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa.