Utility of ultrasound of the lymph nodes in patients with high-risk cutaneous squamous cell carcinoma

Abstract

Background

Ultrasound (US) is a non-invasive, highly available and cheap examination of the lymph nodes of the neck. However, currently, there is no agreement of the standard use of US in the detection of metastatic lymph nodes in patients with high-risk cutaneous squamous cell carcinoma (cSCC). The aim of the study was to evaluate ultrasound in the diagnostics of lymph node metastases in cutaneous squamous cell carcinoma and in the light of different "high-risk" factors in cSCC to evaluate who would benefit from US.

Methods

We conducted a review ofliterature on squamous cell carcinoma of the head and neck (HNSCC) and US published in the year 2000 until September 2017. Nine studies and a total of 664 patients were included. The sensitivity, specificity, negative predictive value and accuracy for US were found in the included articles and a cumulative sum for the total cohort was calculated. Further, the results for US were compared to data from CT, PET CT and clinical examination.

Results

Sensitivity for US for the total cohort was 85.9, specificity was 96.3%, negative predictive value (NPV) was 93.1% and accuracy was 92.2%. We found significantly no difference when US was compared to CT and PET CT. CT had a sensitivity, specificity, NPV and accuracy at 82.8, 97.7, 90.9 and 92.32% respectively. Sensitivity, specificity, NPV and accuracy for PET CT were 87.4, 98.1, 95.2 and 95.2% respectively. In contrast, we found clinical examination to have the significantly lowest sensitivity, specificity, NPV and accuracy at 69.6, 80, 61.1 and 73.4%, respectively.

Conclusions

Ultrasound is found to have equal sensitivity, specificity and NPV as CT and PET CT. Further, US is proven significant better than clinical examination. Patients with one or two high-risk factors for metastases could very well benefit from US of neck. However, more studies on US are necessary and further, specific studies on cSCC should be performed in order to see if US of the neck in HNSCC patients is transferable to cSCC.

Level of evidence: Not ratable.

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