COMPARISON OF CT, MRI & US IN STAGING CERVICAL METASTASE

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The aim of this project is to determine the relative roles of computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound in the evaluation of cervical and retropharyngeal metastatic disease. In patients with squamous cell carcinoma of the upper aerodigestive tract, the presence and extent of cervical metastatic disease is as important as that of the primary site extent in determining treatment and prognosis. Sometimes the volume of neck disease is a dominant prognostic factor. Several features of neck disease are of prime importance in treatment planning including: (1) is the neck positive or negative, (2) number of positive nodes and levels of neck involved, (3) presence of macroscopic capsular penetration and extent of spread to perinodal soft tissues, including likelihood of fixation to the carotid artery or deep neck musculature, and (4) involvement of retropharyngeal, parapharyngeal and tracheoesophageal groove nodes. CT has proven capable of providing all of the above data; however, firm diagnostic criteria and reliability for some of these uses are still not established. MRI has been suggested as a replacement for or adjunct to CT in staging neck disease, but there is little data available on the subject. Ultrasound is a useful adjunct but not a definitive study; its specific role is yet to be established. In this study state-of-the-art CT, MRI and ultrasound will be done on patients with squamous cell carcinoma of the upper aerodigestive tract. The examinations will be done and interpreted without knowledge of the physical findings. The nodes will be mapped on matching diagrams for each imaging modality and by each clinician in charge of the patients. The same map will be drawn based on surgical findings and finally the pathologic examination of the neck specimen. The maps will note all key factors outlined above. Comparison of these data should establish the reliability of each study for each variable of importance, and, ultimately the proper place for each examination in evaluating neck disease. This will, in turn, impact the choice of the primary imaging examination for studying various tumor sites. Many head and neck cancers require imaging prior to treatment; proper sequencing of studies will avoid error and contain costs. Such precise data is required in treating head and neck cancer to control disease while preserving appearance and function.