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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.
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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.
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Introducción: el desarrollo acelerado de la oncología ha condicionado recientes modificaciones terapéuticas que pudieran incluir la preservación de la glándula submandibular en las disecciones de cuello. Objetivos: identificar los criterios para preservar quirúrgicamente la glándula submandibular y exponer los fundamentos científico-teóricos que permitan plantear una modificación actual a la técnica de disección de cuello para conservar esta glándula. Métodos: se realizó una búsqueda exhaustiva retrospectiva de artículos publicados en las bases de datos electrónicas Pubmed, Medline, Cochrane e Hinari desde enero de 2009 hasta julio de 2014, en las revistas Head and Neck, Otolaryngology and Head and Neck Surgery y The Laryngoscope con los términos: preservación glándula submandibular, criterios oncológicos conservar glándula submandibular, modificaciones disecciones linfonodulares cervicales, sin restricciones idiomáticas. Se incluyeron solo los artículos publicados durante los últimos cinco años, cuyo material y método reflejara: estudios poblacionales, disecciones de cuello como tratamiento oncoespecífico y confirmación anatomo-patológica para concluir el diagnóstico. Análisis e integración de la información: de 3 estudios que conformaron una metapoblación de 829 pacientes, donde se preservó la glándula submandibular en un grupo de pacientes con tumores de cavidad bucal y orofaringe y disecciones de cuello simultáneas, se evidenció que no hubo diferencias en cuanto a recaída local, regional, a distancia ni sobrevida al compararlos con otro grupo de pacientes donde la disección de cuello no incluyó este proceder. Conclusión: los estudios coinciden en el bajo riesgo de metástasis ocultas a la glándula por carcinomas escamosos de cabeza y cuello, xerostomía posquirúrgica y factibilidad de la técnica quirúrgica como fundamentos para preservar la submandibular, de igual manera en que la ausencia de terapia oncoespecífica anterior, linfonódulos positivos en el subnivel IB y relación entre el tumor primario y la glándula son criterios necesarios en la selección de candidatos para realizar este proceder(AU)
Introduction: as a result of the swift development of oncology, some therapeutic modifications have recently been considered, among them the potential preservation of the submandibular gland in neck dissections. Objectives: identify the criteria to surgically preserve the submandibular gland and expound the theoretical scientific foundations allowing to set forth a modification to neck dissection technique with a view to preserving this gland. Methods: an exhaustive retrospective search was conducted of papers published in the databases Pubmed, Medline, Cochrane and Hinari from January 2009 to July 2014. The journals surveyed were Head and Neck, Otolaryngology and Head and Neck Surgery, and The Laryngoscope. The search terms used were submandibular gland preservation, oncological criteria preserve submandibular gland, modifications cervical lymph node dissections, without any language restrictions. Only papers published in the last five years were included. On the other hand, their materials and methods section should make reference to population studies, neck dissection as an onco-specific treatment, and anatomopathological confirmation of the diagnosis. Data analysis and integration: three studies with a metapopulation of 829 patients referred to a group of patients with oral and oropharyngeal tumors and simultaneous neck dissections whose submandibular gland had been preserved. These studies do not report any difference as to local, regional or distant relapse or survival when compared with another group of patients in whom neck dissection did not include such a procedure. Conclusion: all studies referred to the following aspects: the low risk of occult metastasis to the gland from head and neck squamous cell carcinomas, postsurgical xerostomia, and the feasibility of the surgical technique as foundations for the preservation of the submandibular gland. They also referred to the fact that absence of prior onco-specific therapy, positive lymph nodes in sublevel IB, and the relationship between the primary tumor and the gland are all required criteria for the selection of candidates for the procedure(AU)