Computed tomography in the management of cervical lymph node pathology

Area of Science:

• Oncology
• Radiology
• Head and Neck Surgery

Background:

• Cervical lymph node metastasis is critical in head and neck carcinoma staging.
• Standardized criteria for Computerised Tomography (CT) analysis are needed for reliable outcome comparison in head and neck oncology.

Purpose of the Study:

• To compare the diagnostic performance of two different Computerised Tomography (CT) criteria (10mm vs. 15mm lymph node size cutoff) for detecting cervical lymph node metastasis in head and neck tumors.
• To evaluate the accuracy of clinical palpation against CT-based criteria.

Main Methods:

• Prospective study of 55 patients with head and neck tumors (minimum T2 intraoral squamous cell carcinoma or high-risk extraoral malignancies).
• Comparison of sensitivity, specificity, and accuracy for clinical palpation, CT with a 10mm cutoff, and CT with a 15mm cutoff.
• 65 neck dissections were performed for pathological correlation.

Main Results:

• Clinical palpation: sensitivity 86%, specificity 84%, accuracy 85%.
• CT (10mm cutoff): sensitivity 95%, specificity 47%, accuracy 63%.
• CT (15mm cutoff): sensitivity 86%, specificity 81%, accuracy 83%.

Conclusions:

• A 15mm cutoff for CT evaluation of cervical lymph nodes is superior to a 10mm cutoff for head and neck tumors, reducing the risk of overtreatment.
• In this study, Computerised Tomography (CT) alone did not demonstrate a significant advantage over clinical palpation in terms of overall accuracy for cervical lymph node assessment.