Infra-hyoid metastases in supra-hyoid squamous cell carcinoma

The CT scans of 71 patients with primary squamous cell tumours of head and neck sites were reviewed and compared with clinical examination in the assessment of lymph nodes above and below the hyoid. Above the hyoid, CT and clinical examination disagreed on the presence or absence of metastases in 13/42 cases (31%); below the hyoid where palpation is presumably easier, there was disagreement in 1 of 10 cases (10%). Abandoning infra-hyoid scans to save scanner time would save only seven slices on average per case and it is possible that further, clinically silent lesions would be missed. We conclude that staging scans in head and neck cancer should continue to include the infra-hyoid region. The inadequacies of existing knowledge based on clinical staging are discussed.