Source: Doctor’s Guide (www.docguide.com)
Author: Arushi Sinha

Ultrasound-guided fine-needle aspiration is a technique that has low specificity for diagnosis of head and neck cancers following chemotherapy and radiotherapy interventions, researchers reported here at the American Head and Neck Society (AHNS) 7th International Conference on Head and Neck Cancer.

Lisa van der Putten, MD, Department of Otolaryngology — Head and Neck Surgery, VU University Medical Centre, Amsterdam, Netherlands, presented research focused on optimising prognostic techniques for patients with head and neck cancers receiving chemotherapy and radiotherapy.

“This is one of the first studies to examine the effectiveness of prognostic techniques, like ultrasound-guided fine-needle aspiration, following chemoradiation for head and neck cancer,” Dr. van der Putten explained during a presentation on July 20.

Lymph node metastasis is one of the most significant prognostic factors for patients with head and neck carcinomas, so Dr. van der Putten and colleagues examined a variety of strategies for prognosis of these patients following chemotherapy and radiotherapy interventions.

The objectives of their study were to evaluate the effectiveness of ultrasound-guided fine-needle aspiration and to determine some of the prognostic factors for outcomes following chemoradiation.

Both modified radical neck dissection (MRND) and selective neck dissection (SND) are used as treatment methods for patients with head and neck carcinomas who are at high risk for metastatic cancer. The study team evaluated the effectiveness and safety of an observational approach to lymphadenopathy following these surgical interventions.

The study followed outcomes of 61 patients who underwent salvage neck dissections for suspected recurrence. Of this patient group, 26 (43%) patients were found to have a vital tumour requiring further intervention. Thirteen patients underwent SND, and the other 13 patients underwent MRND.

The 5-year regional control rate was 79%, and the overall survival rate was 36%. In addition, looking at the efficacy of ultrasound-guided fine-needle aspiration, the researchers found that the procedure had an 80% sensitivity rate with a 42% specificity rate, resulting in a 40% positive predictive value and an 81% negative predictive value.

Importantly, the team also found that the presence of positive surgical margins (P < .001) and the presence of residual disease (P = .03) were significantly linked to adverse overall outcomes.

Based on these findings, particularly those of fine-needle aspiration, the authors concluded that there may be room for improved diagnostic techniques. “The ultrasound-guided fine-needle aspiration has low specificity,” Dr. van der Putten concluded.

[Presentation title: Effectiveness of Selective and Radical Neck Dissection for Regional Pathological Lymphadenopathy After Chemoradiation. Abstract P060]