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Soo Park, MD
Soo Park, MD
Posted: Tuesday, February 1, 2022
Ultrasonography may be a more sensitive way of screening for the presence of lymph node metastasis of cutaneous squamous cell carcinoma compared with clinical examination alone, according to Marlies Wakkee, MD, PhD, of the University Medical Center Rotterdam, the Netherlands, and colleagues. However, the researchers also found that ultrasonography yielded a high rate of false-positive results after a negative result at baseline clinical examination. These findings were published in JAMA Dermatology.
Researchers studied a retrospective cohort of 233 patients with 246 high-risk cutaneous squamous cell carcinoma tumors of the head and neck. All patients received a clinical evaluation of their regional lymph nodes and baseline ultrasonographic imaging. A negative finding for metastasis was assumed when clinical palpitation or presence of physical swelling was not found.
Of the 233 patients clinically examined, lymphadenopathy was observed in 20 of 246 tumors (8.1%). Fine-needle aspiration cytologic biopsy (FNAC) revealed 11 metastatic tumors. Clinical examination sensitivity was 50% (95% CI = 28%–72%) and specificity was 96% (95% CI = 93%–98%). In 70 of 246 cases (28.5%), suspicious lymph nodes were identified using ultrasonography. FNAC confirmed lymph node metastasis in 20 patients. Baseline ultrasonography sensitivity for the entire cohort was 91% (95% CI = 71%–99%). Excluding all patients who had one or more suspicious lymph nodes found during baseline clinical examination, 226 tumors were examined using ultrasonography, with a high sensitivity (82%; 95% CI = 48%–98) and a low positive predictive value (17%; 95% CI = 12%–23%). Of the 226 tumors examined, 54 were deemed suspicious. FNAC revealed that 9 tumors were metastases, with 45 false-positive results.
“Although ultrasonographic examination is highly sensitive for the detection of both clinically visible and occult lymph node metastasis, this sensitivity needs to be evaluated against the consequences of many false-positive ultrasonographic results,” the researchers concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
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