Role of US and CT in detection of neck metastases of squamous cell carcinomas

Objective: To optimize the selection of patients eligible for surgical neck treatment optimizing a diagnostic routine to identify neck metastases. Methods: Comparison between sensibility, specificity and diag- nostic accuracy of clinical examination, echography (US), com- puted tomography (CT) in detection of cervical metastases in 53 patients with carcinoma of the upper aerodigestive tract. Results: Clinical examination: sensibility 82.1%, specificity 80%, diagnostic accuracy 81.1%—US with a cut off point for minimal adenopathy diameter of 0.5 cm sensibility 92.8%, specificity 77.3%, diagnostic accuracy 77.3%—US with a cut off point of 1 cm sensibility 82.1%, specificity 80%, diagnostic accuracy 81.1%—US with a cut off point of 1 cm, also considering round shape of multiplicity of the adenopathy: sensibility 82.1%, speci- ficity 80%, diagnostic accuracy 81.1%—CT with cut off point 0.5 cm: sensibility 92.8%, specificity 32%, diagnostic accuracy 64.1%—CT with cut off point 1 cm: sensibility 85.7%, specificity 64%, diagnostic accuracy 75.4%—CT with cut off point 1 cm, also considering central necrosis, extracapsular spread, multi- plicity of adenopathy: sensibility 89.2%, specificity 60%, diag- nostic accuracy 75.5%. Conclusions: (a) A neck positive to palpation must be submitted to neck dissection (81.1% possibility of having a metastases); (b) a neck negative to palpation must be further investigated using the US and CT cut off point of 1 cm; (c) the combined use of US and TC does not offer remarkable advantages in detection of metastases.