Abstract
I am writing to respond to Dr Portilla's letter to the editors concerning our published article entitled "Improving Diagnostic Accuracy of Cervical Metastases With Computed Tomography and Magnetic Resonance Imaging." In our results we stated that computed tomography and magnetic resonance imaging were found to be superior over physical examination in sensitivity values, false-positive values, false-negative values, and overall efficiency predictive values. However, these values did not achieve statistical significance. We then summarized a recent up-to-date literature review from 1984 to present that showed five out of six institutions were in agreement with our findings. Two of these, Friedman et al<sup>1</sup>and Close et al<sup>2</sup>were statistically significant. At this point in time we feel that this provoking and controversial issue is unfolding to support the side of utilizing either computed tomography or magnetic resonance imaging in the preoperative staging assessment. However, continued evaluation in
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