F-Fluorodeoxyglucose Positron Emission Tomography to Evaluate Cervical Node Metastases in Patients With Head and Neck Squamous Cell Carcinoma: A Meta-analysis

JNCI Vol. 100, Issue 10 | May 21, 2008 The presence of cervical lymph node metastasis is an important prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). However, the management of patients without neck metastases, as determined from physical examination (ie, clinically negative neck, cN0), remains controversial ( 1 , 2 ). These patients usually undergo elective neck treatment (ie, elective neck dissection or radiotherapy) when the risk of occult cervical lymph node metastases is expected to be greater than 15% – 20% ( 1 – 4 ). The probability of occult metastatic disease is estimated based on tumor stage, location, and histological characteristics. However, both the morbidity and the cost of the elective neck treatment are high because the majority of treated patients do not harbor cervical lymph node metastases. Thus, imaging techniques are often used to enhance the preoperative assessment of cervical lymph node status ( 5 , 6 ). Computed tomography (CT) and magnetic resonance imaging (MRI) are similar to each other in rates of detection of cervical lymph node metastases and may detect some occult nodal metastases that are missed by physical examination ( 5 – 8 ). However, the overall diagnostic accuracy of CT and MRI for detecting metastases in the cN0 neck is insufficient ( 5 , 9 ); sensitivities range from 14% to 80% for CT and from 29% to 85% for MRI ( 5 , 10 , 11 ), and specificities range from 80% to 100% for