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A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection

OBJECTIVES: Management of neck metastases in terms of diagnosis and treatment has always been a controversial issue in patients of head and neck malignancy. The main area of debate in case of diagnosis lies with the fact that whether we should rely on ultrasound, as a diagnostic modality for diagnos...

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Autores principales: Mehta, Nitika, Sharma, Rohit, Madhok, Rajneesh, Agrawal, Tanu, Sharma, Vinit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846226/
https://www.ncbi.nlm.nih.gov/pubmed/29552528
http://dx.doi.org/10.4103/ijabmr.IJABMR_391_16
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author Mehta, Nitika
Sharma, Rohit
Madhok, Rajneesh
Agrawal, Tanu
Sharma, Vinit
author_facet Mehta, Nitika
Sharma, Rohit
Madhok, Rajneesh
Agrawal, Tanu
Sharma, Vinit
author_sort Mehta, Nitika
collection PubMed
description OBJECTIVES: Management of neck metastases in terms of diagnosis and treatment has always been a controversial issue in patients of head and neck malignancy. The main area of debate in case of diagnosis lies with the fact that whether we should rely on ultrasound, as a diagnostic modality for diagnosing micrometastases in the neck in head and neck malignancy patients? The second controversial issue is the management of N0 neck, whether to be radical or conservative? MATERIALS AND METHODS: This study was conducted on 70 diagnosed patients of head and neck carcinoma who were planned for resection of the primary. An appropriate neck dissection was performed in all the patients, and their clinical, ultrasonography, and postoperative histopathological neck findings were correlated. RESULTS: In our center, the most common site of the primary tumor was oral cavity with most involving buccal mucosa. As expected, T4 lesions were commonly associated with nodal metastasis (71%). The sensitivity of clinical examination and ultrasound was 80% and 93.3%, respectively, and specificity of clinical examination and ultrasound was 57% and 27.2%, respectively. Histopathologically positive but clinically nonpalpable metastases in the study group were more frequent in levels Ib, II, and III, respectively. CONCLUSION: We concluded that ultrasonography being a low cost and a highly sensitive investigation can act in tandem with clinical examination for diagnosing the neck for metastases preoperatively in head and neck malignancy patients. However, due to its low specificity, we cannot completely rely on it, hence doing a neck dissection in selective form, will definitely improve the clinical course of the disease in N0 necks.
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spelling pubmed-58462262018-03-16 A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection Mehta, Nitika Sharma, Rohit Madhok, Rajneesh Agrawal, Tanu Sharma, Vinit Int J Appl Basic Med Res Original Article OBJECTIVES: Management of neck metastases in terms of diagnosis and treatment has always been a controversial issue in patients of head and neck malignancy. The main area of debate in case of diagnosis lies with the fact that whether we should rely on ultrasound, as a diagnostic modality for diagnosing micrometastases in the neck in head and neck malignancy patients? The second controversial issue is the management of N0 neck, whether to be radical or conservative? MATERIALS AND METHODS: This study was conducted on 70 diagnosed patients of head and neck carcinoma who were planned for resection of the primary. An appropriate neck dissection was performed in all the patients, and their clinical, ultrasonography, and postoperative histopathological neck findings were correlated. RESULTS: In our center, the most common site of the primary tumor was oral cavity with most involving buccal mucosa. As expected, T4 lesions were commonly associated with nodal metastasis (71%). The sensitivity of clinical examination and ultrasound was 80% and 93.3%, respectively, and specificity of clinical examination and ultrasound was 57% and 27.2%, respectively. Histopathologically positive but clinically nonpalpable metastases in the study group were more frequent in levels Ib, II, and III, respectively. CONCLUSION: We concluded that ultrasonography being a low cost and a highly sensitive investigation can act in tandem with clinical examination for diagnosing the neck for metastases preoperatively in head and neck malignancy patients. However, due to its low specificity, we cannot completely rely on it, hence doing a neck dissection in selective form, will definitely improve the clinical course of the disease in N0 necks. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC5846226/ /pubmed/29552528 http://dx.doi.org/10.4103/ijabmr.IJABMR_391_16 Text en Copyright: © 2018 International Journal of Applied and Basic Medical Research http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Mehta, Nitika
Sharma, Rohit
Madhok, Rajneesh
Agrawal, Tanu
Sharma, Vinit
A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection
title A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection
title_full A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection
title_fullStr A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection
title_full_unstemmed A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection
title_short A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection
title_sort clinical, radiological, and histopathological correlation of neck nodes in patients undergoing neck dissection
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846226/
https://www.ncbi.nlm.nih.gov/pubmed/29552528
http://dx.doi.org/10.4103/ijabmr.IJABMR_391_16
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