Pre- and intra-operative staging of the neck in a developing world practice

Most patients with squamous cancer of the head and neck treated at Groote Schuur Hospital are from a poor socio-economic background with a high prevalence of tuberculosis (TB), human immunodeficiency virus (HIV) and other infections that may cause cervical lymphadenopathy resulting in overstaging of the neck. A retrospective review of 186 patients requiring therapeutic and elective neck dissection was undertaken and the sensitivity and specificity of clinical and intra-operative staging of the neck determined. Results showed overall sensitivity of staging at 80.1 per cent. Specificity was 52.2 per cent. Staging of the N(1), N(2b) and N(2c) necks had positive predictive values of 53.2, 65.8 and 68.2 per cent respectively. Occult nodal metastases were present in 32 per cent elective neck dissections (END)s. Specificity of intra-operative staging of the N(0) neck was 33.3 per cent and sensitivity was 72.4 per cent. Conclusions were that our indications for elective neck dissection are appropriate. The high false positive rates for staging of the N(1), N(2b) and N(2c) necks, necessitate a change in management strategy.