Accuracy of the preoperative diagnostic workup in patients with head and neck cancers undergoing neck dissection in term
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HEAD AND NECK
Accuracy of the preoperative diagnostic workup in patients with head and neck cancers undergoing neck dissection in terms of nodal metastases Angéla Horváth1 · Péter Prekopp1 · Gábor Polony1 · Eszter Székely2 · László Tamás1 · Kornél Dános1 Received: 16 July 2020 / Accepted: 24 August 2020 © The Author(s) 2020
Abstract Purpose The presence of cervical lymph node metastases is one of the most influential prognostic factors in head and neck squamous cell carcinomas. The management of clinically N0 neck in patients with head and neck cancer remains controversial: elective neck dissection has relatively high morbidity, adversely affecting the quality of life, however, abandoning elective neck dissection is known to compromise overall survival in numerous primaries. The purpose of this study was to evaluate the accuracy of the conventional imaging modalities (CT, MRI, US) and fine-needle aspiration cytology (FNAC) in the detection of lymph node metastases in the neck. Methods Sixty two patients were included in the study, who underwent primary tumor resection and neck dissection. Preoperative nodal status was compared with postoperative histopathology nodal status. In our retrospective study, we reviewed the patient documentation. Statistical analysis of the data—with descriptive statistics and correlation analysis—was performed with Chi-square test. Results The sensitivity of conventional imaging modalities and FNAC were 82.8% and 81.8%, respectively, while specificity were 73.9% and 100%, respectively. Positive predictive value calculated for imaging modalities and FNAC were 82.8%, 100%, respectively, while negative predictive values were 73.9% and 66.6%, respectively. Conclusion Neither the sensitivity of imaging modalities (CT, MRI, US) nor FNAC reached 100%, none of these methods can definitively exclude the presence of regional tumor metastasis. According to these data, no permissive alteration should be allowed from the current guidelines (e.g. NCCN) based on imaging/FNAC examinations regarding the need for elective neck dissection. Keywords Imaging · Head and neck · Squamous cell carcinoma · Ultrasound · FNAC · Neck dissection
Purpose The presence of cervical lymph node metastases is one of the most influential prognostic factors in head and neck squamous cell carcinomas. Adequate treatment based on precise preoperative diagnostic work-up is crucial for achieving the desired oncologic outcome [1]. The indication for neck * Kornél Dános [email protected]‑univ.hu 1
Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest 1083, Hungary
2nd Department of Pathology, Semmelweis University, Budapest, Hungary
2
dissection can be either therapeutic (for clinically N + necks) or elective (for clinically N0 necks). Most currently available guidelines recommend comprehensive neck dissection (levels I–V.) if preoperative examinations (physical examination, imaging, FNAC) reveal pathologic lymph nodes. Based on classic textbooks, elec
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