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Metastatic neck disease. A clinical/radiographic/pathologic correlative study.
R Feinmesser1, J L Freeman, A M Noyek
1Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Archives of Otolaryngology--Head & Neck Surgery
|December 1, 1987
Summary
High-resolution computed tomographic (CT) scanning showed no advantage over physical examination for detecting neck metastases in head and neck cancer patients. This finding suggests CT should not guide neck management decisions.
Area of Science:
- Oncology
- Radiology
- Head and Neck Surgery
Background:
- Prophylactic neck treatment in head and neck cancer is common due to potential metastases.
- Accurate detection of neck metastases could spare some patients from overtreatment.
Purpose of the Study:
- To compare the efficacy of high-resolution computed tomographic (CT) scanning versus physical examination in identifying neck metastases.
- To determine if CT scanning offers an advantage over physical examination for neck management decisions in head and neck cancer.
Main Methods:
- A retrospective comparative study involving 79 head and neck cancer patients.
- Comparison of radiographic findings from CT scans with physical and histopathologic examinations in 100 neck dissections.
Main Results:
- Physical examination sensitivity: 61.55%; CT scanning sensitivity: 59.6%.
- Physical examination positive predictive value: 91.4%; CT scanning positive predictive value: 81.6%.
- Occult lymph node sizes were indistinguishable from normal nodes.
Conclusions:
- High-resolution CT scanning provides no significant advantage over physical examination for managing the neck in head and neck cancer.
- CT scanning should not be relied upon for neck management decisions in this patient population.