ABSTRACT: To assess the diagnostic certainty of CT images to identify regional spread of head and neck tumours.
A CT study was performed on 86 patients with neoplasms in the larynx and/or pharynx. After this, surgical dissection was performed for 142 neck sides. In the imaging study the following parameters were considered for all patients before suspecting malignant nodes: size of adenopathy bigger than 10-11 mm, irregular borders, central necrosis, spherical shape, capsular enhancement and presence of groups with three or more lymphadenopathies.
48.5 % of dissections were N+. Sensitivity and specificity for physical examination were 59 % and 82 %, respectively, against 73 % and 86 % for CT. Lymph node necrosis was the pattern with the greatest sensitivity and specificity (35.8 % and 100 %, respectively) and its accuracy was 69.7 %. Accuracy was 60.5 % for spherical shape, 59.8 % for node size, and between 54 % and 58 % for the other three criteria. In the histopathological findings, 25 % of neck dissections were N+ when only one pattern had been detected on CT, whereas those neck sides in which four patterns were identified simultaneously showed regional spread in 100 %.
The presence of specific morphological imaging criteria for head and neck tumours in cervical lymph nodes and their concomitance increase the accuracy of imaging to predict regional spread.
Acta Otorrinolaringológica Española 07/2008; 59(6):257-62.