Comparison of Clinical Examination and Various Imaging Modalities in the Diagnosis of Head and Neck Cancer

Abstract

Introduction Squamous cell Carcinoma of the Head and Neck (HNSCC) is the most common tumor entity of malignant processes in the head and neck area. Due to the metastasizing behavior of these tumors, the staging is indispensable for the treatment planning and requires imaging techniques, which are sensitive, specific, and as far as possible cost-effective, to benefit ultimately the patient and to ensure optimal care. Objectives The aim of the present study is to compare the clinical examination including palpation, ultrasound and computed tomography (CT)/magnetic resonance imaging (MRI) for the diagnosis of neck metastases to make the correct indication for a neck dissection. Methods Data from 286 patients with HNSCC were analyzed for neck metastases to determine which diagnostic tool is the best to answer the question if a neck dissection is necessary or not. Each study method was examined retrospectively by comparing sensitivity, specificity, the positive/negative predictive value, the positive likelihood ratio and the diagnostic accuracy. Results The ultrasound showed a sensitivity of 91.52%, a specificity of 61.67%, a positive/negative predictive value of 76.65%/84.09%, a positive likelihood ratio of 2.39 and a diagnostic accuracy of 78.95%. The clinical examination showed a sensitivity of 75.76%, a specificity of 66.12%, a positive/negative predictive value of 75.30%/66.67%, a positive likelihood ratio of 2.24 and a diagnostic accuracy of 71.68%. The CT/MRI showed a sensitivity of 78.66%, a specificity of 62.50%, a positive/negative predictive value of 74.14%/68.18%, a positive likelihood ratio of 2.10 and a diagnostic accuracy of 71.83%. Radiographically, ultrasound, as well as the clinical examination, could be judged to be free from radiation load and side effects from the contrast medium. The high dependence on the investigator when using ultrasound made reproducibility of the results difficult. Conclusions It could be shown that ultrasound was the diagnostic tool with the highest sensitivity, positive/negative predictive value, positive likelihood ratio and diagnostic accuracy by detecting and interpreting metastases in the head and neck region correctly. Whether a neck dissection should be performed depends to a large extent on the ultrasound findings.

Quantitative Multiparametric Ultrasound (mpUS) in the Assessment of Inconclusive Cervical Lymph Nodes

“…Due to the superficial localization, B-Mode ultrasound (US) is the primary imaging modality for detection and characterization by the use of high-frequency linear transducers [ 9 ]. Well known criteria for malignant lymph node transformation are round shape and loss of fatty hilus or cystic changes and Solbiati Index (ratio long-axis/short-axis) < 2 [ 10 , 11 ].…”

The Diagnostic Performance of Multiparametric Ultrasound in the Qualitative Assessment of Inconclusive Cervical Lymph Nodes

“…Many HNSCCs first present with signs and symptoms of CLN metastasis [2], where CLN involvement is a prognostic factor and influences the choice of treatment [3,4]. Close monitoring of CLNs is recommended in HNSCC patients [5], with ultrasound (US) being the image modality of choice [6]. In B-mode US, benign CLNs have an oval shape, a well-defined border and a hilus sign.…”

“…Deviations from any of these morphological features are considered indicators of potential malignant involvement [7]. Even though the combination of B-mode US and CCDS shows a higher diagnostic performance than computer tomography or magnetic resonance imaging of the neck, its sensitivity of 66-91% and specificity of 61-78% are not yet satisfying [6,8]. Recent studies have demonstrated the added value of utilizing preoperative quantitative multiparametric US (mpUS) in inconclusive CLNs [9][10][11].…”