PhD Scientific Days 2021

CL_VII_L: Clinical Medicine VII. Lectures

The Diagnostic Accuracy of Preoperative Diagnostic Workup in Patients with Head and Neck Cancers Undergoing Neck Dissections in Terms Of Nodal Metastases

Text of the abstract

Introduction
The presence of cervical lymph node metastases is one of the most influential prognostic factors in head and neck squamous cell carcinomas. The management of clinically N0 (cN0) neck in patients with head and neck cancer remains controversial: elective neck dissection has relatively high morbidity, adversely affecting the quality of life, however, abandoning elective neck dissection is known to compromise overall survival in numerous primaries.
Aims
The purpose of this study was to evaluate the accuracy of the conventional imaging modalities (CT, MRI, US) and fine-needle aspiration citology (FNAC) in the detection of lymph node metastases in the neck.
Methods
62 patients were included in the study, who underwent primary tumor resection and neck dissection. Preoperative nodal status (cN) was compared with postoperative histopathology nodal status (pN).
In our retrospective study, we reviewed the patient documentation. Statistical analysis of the data – with descriptive statistics and correlation analysis – was performed with Chi-square test.
Results
Sensitivity of conventional imaging modalities and FNAC were 82.8% and 81.8%, respectively, while specificity were 73.9% and 100%, respectively. Positive predictive value (PPV) calculated for imaging modalities and FNAC were 82.8%, 100%, respectively, while negative predictive values were (NPV) 73.9% and 66.6%, respectively.
Conclusion
Neither the sensitivity of imaging modalities (CT, MRI, US) nor FNAC reached 100%, none of these methods can definitively exclude the presence of regional tumor metastasis. According to these data, no permissive alteration should be allowed from the current guidelines (e.g. NCCN) based on imaging/FNAC examinations regarding the need for elective neck dissection.
Funding
We didn't get any funding

University and Doctoral School

Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine