Lymph nodal volume in head and neck malignancy: can adding a third dimension improve the detection of nodal metastasis?

Abstract

BackgroundTo compare the diagnostic utility of computed tomography (CT) and ultrasonography (USG) for preoperative determination of metastatic lymph nodes.MethodsHead and neck squamous cell carcinoma (HNSCC) cases planned for neck dissection were included. All underwent preoperative neck USG and CT followed by histopathological evaluation after surgery. Sensitivity, specificity, positive and negative predictive value along with accuracy was calculated for each outcome variable. Efficacy was calculated by comparing these to postoperative histopathology. Both imaging modalities were compared with lymph nodal volume.ResultsEighty-seven lymph nodes were selected from 30 patients. Median volume on CT was 5412.15 mm3 for metastatic and 237.7 mm3 for benign nodes and on ultrasound, 4168.92 mm3 for metastatic and 233.1 mm3 for benign nodes (p < 0.001). Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for volume on USG were 81.8%, 98.7%, 96.6%, 90%, and 97.4% and on CT were 81.8%, 100%, 97.7%, 100%, and 97.4% respectively.ConclusionsLymph nodal volume had higher sensitivity and specificity for detection of metastatic cervical lymphadenopathy and individually or in combination should be included as one of the criteria in preoperative assessment of HNSCC.