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Observer error in the assessment of nodal disease in head and neck cancer
D J Alderson1, T M Jones, S J White
1Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL United Kingdom.
Background:
There is no previously published information on clinicians' abilities to accurately differentiate between different stages of node positive disease in head and neck cancer.
Methods:
Forty-two surgeons examined standardized nodes in a model neck and estimated nodal size. Each recorded their confidence in their ability to perform the task using a visual analogue scale. Reference nodes of known size were provided for comparison during a second examination of each node. The study was repeated after 1 month.
Results:
Accuracy was poor and was not dependent on experience or confidence. There was a tendency to underestimate the size of smaller nodes. Estimates were strongly influenced by volume independent of largest diameter (p <.001). Reference nodes aided accuracy (p =.031). Subjects were not consistent on repeated testing (p <.001).
Conclusions:
Both trainees and specialists are poor at accurately staging nodal disease using palpation alone.
