Assessment of cervical lymph node metastasis with different imaging methods in patients with head and neck squamous cell carcinoma

Objective: To determine the predictive value of different imaging methods,-computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and single-photon emission tomography (SPECT),-for cervical node metastasis. Design: Prospective clinical trial. Setting: An academic otolaryngology department. Methods: Twenty-three consecutive patients with head and neck malignancy were prospectively evaluated for the presence of cervical lymphadenopathy. All patients underwent clinical, CT, MRI, US, and SPECT examinations. Neck dissection was performed for 31 neck sides, and the results of the preoperative evaluation were confirmed by the surgical and histopathologic findings. Main Outcome Measures: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each method and a comparison of the methods was done. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT, MRI, US, and SPECT were 77.7%, 85.7%, 91.3%, 66.6%, and 80.4%; 59.2%, 92.8%, 94.1%, 54.1%, and 70.7%; 81.4%, 64.2%, 81.4%, 64.2%, and 75.6%; 55.5%, 92.8%, 93.7%, 52.0%, and 68.2%, respectively. Both CT and US were found to be superior to clinical examination. There was no statistically significant difference between US and CT. US was found to be superior to MRI and SPECT in detecting cervical node metastasis. CT was also superior to SPECT. Conclusion: Our data show that, despite high specificity rates, especially with SPECT, none of the currently available imaging methods are reliable in evaluating the occult regional metastasis because the negative predictive values of all of these methods are rather low.