Palpation, ultrasound, and ultrasound-guided fine-needle aspiration cytology in the assessment of cervical lymph node status in head and neck cancer patients

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Abstract
Background Lymph node status of the neck is the most important prognostic factor in head and neck cancer patients. Assessment of the lymph nodes status is still often based on palpation only, although the low accuracy of palpation is known. Methods Altogether 105 consecutive head and neck cancer patients were examined using ultrasound (US) and ultrasound‐guided fine‐needle aspiration cytology (FNAC) to evaluate the additional information obtained by these methods. Results Of the 86 patients with palpable normal necks, FNAC taken under US‐guidance showed malignancy in 13. The US size criteria for malignancy were fulfilled in 7 of these patients, whereas the lymph nodes were of normal size in 6 of them. In the whole patient material, US‐guided FNAC showed bilateral metastasis in 3 patients although only unilateral or no metastasis was found by palpation. Conclusion US combined with US‐guided FNAC can be recommended as a method for evaluating for regional metastases in head and neck cancer patients, both for those with and those without palpable metastasis. HEAD & NECK 1996;18:545–551 © 1996 John Wiley & Sons, Inc.