Assessment of Cervical Lymph Nodes in Squamous Cell Carcinoma of the Head and Neck

Abstract

Background: The most important prognostic factor in squamous cell carcinoma of the head and neck is the presence or absence of clinically involved neck nodes. The presence of metastases in a lymph node is said to reduce the 5-years survival rate by about 50%. The appropriate diagnosis of the presence of metastatic node is very important for the management of squamous cell carcinoma of the head and neck. The aim of this work is to study the status of cervical lymph nodes in known cases of squamous cell carcinoma in the head and neck and their relation to the primary site. Methods: This study was carried out on 100 consecutive patients with a histologically proven non-cutaneous Head and Neck Squamous Cell Carcinoma (HNSCC). Every patient was subjected to clinical examination for cervical lymph nodes, CT scan on the neck with intravenous contrast and gray scale ultrasound scanning on the neck. Results: Clinical palpation for cervical lymph nodes had a sensitivity of 71.43%, specificity 75.86% and accuracy 72.7%. CT scan was better than clinical palpation. The sensitivity for CT was 82.9%, while the specificity was 89.66% and the accuracy was 84.85%. Ultrasound scanning was found to be the best modality in assessment of metastases in cervical lymph nodes. The sensitivity was 97.1%, the specificity was 93% and the accuracy was 95.96%. The positive predictive value for Ultrasound scanning was 97.1% and the negative predictive value was 93%. Conclusion: CT and ultrasound scanning increase the accuracy of lymph node detection. Although CT is better than clinical palpation, it is also considered inferior to ultrasound scanning in this aspect. Besides, ultrasound scanning is cheaper and with no hazards of radiation exposure.