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Pre- and intra-operative staging of the neck in a developing world practice

Published online by Cambridge University Press:  31 May 2006

Patrick J. de Waal ,
Johannes J. Fagan  and
Sedick Isaacs
Patrick J. de Waal
Affiliation:
Division of Otolaryngology, University of Cape Town Medical School, Cape Town, South Africa.
Johannes J. Fagan
Affiliation:
Division of Otolaryngology, University of Cape Town Medical School, Cape Town, South Africa.
Sedick Isaacs
Affiliation:
Department of Medical Informatics, Groote Schuur Hospital, Cape Town, South Africa.
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Abstract

Most patients with squamous cancer of the head and neck treated at Groote Schuur Hospital are from a poor socio-economic background with a high prevalence of tuberculosis (TB), human immunodeficiency virus (HIV) and other infections that may cause cervical lymphadenopathy resulting in overstaging of the neck.

A retrospective review of 186 patients requiring therapeutic and elective neck dissection was undertaken and the sensitivity and specificity of clinical and intra-operative staging of the neck determined.

Results showed overall sensitivity of staging at 80.1 per cent. Specificity was 52.2 per cent. Staging of the N1, N2b and N2c necks had positive predictive values of 53.2, 65.8 and 68.2 per cent respectively. Occult nodal metastases were present in 32 per cent elective neck dissections (END)s. Specificity of intra-operative staging of the N0 neck was 33.3 per cent and sensitivity was 72.4 per cent.

Conclusions were that our indications for elective neck dissection are appropriate. The high false positive rates for staging of the N1, N2b and N2c necks, necessitate a change in management strategy.

Keywords

Head and Neck NeoplasmsLymphatic MetastasisTuberculosisAcquired ImmunodeficiencySyndromeRadical Neck DissectionSensitivity and Specificity
Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 117 , Issue 12 , December 2003 , pp. 976 - 978
Copyright
© Royal Society of Medicine Press Limited 2003

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