Re-Evaluation of Neck Staging by Computed Tomography Scan, Magnetic Resonance Imaging and Elective Neck Dissection in Clinically N0 Neck in Head and Neck Cancers and Its Histo-Pathological Correlation

Objective: Thirty percent of all cancer cases are head and neck cancer. The most frequent way that these tumors spread is through lymphatic metastasis. In patients with head and neck tumors, cervical lymph node assessment is a crucial step in the staging process. Furthermore, the prognosis of patients with head and neck malignancies is greatly influenced by the identification of cervical lymph node metastases. The modalities available to detect metastatic lymph nodes are ultrasound, computed tomography, magnetic resonance imaging, and scintigraphy. Our study is done to compare the efficacy of clinical examination, computed tomography, magnetic resonance imaging, and histopathological correlation after elective neck dissection and staging of lymph node metastasis in head and neck cancers. Methods: This prospective study was carried out in the Department of Otorhinolaryngology at Hitech Medical College and Hospital, Rourkela, Odisha, between January 2023 and December 2024 in association with the department of radiodiagnosis. A total of 30 patients of all age groups and both sexes with clinically N0 neck with proven head and neck cancer and requiring surgery as the primary mode of treatment were included in the study. All CT and MRI images were assessed by a radiologist without prior knowledge of the clinical status of the patient. The result of the clinical examination, CT scan, and MRI was compared with the histopathological report. Results: In the present study, the majority of patients ranged between the age group of 40-60 years (66.6%), with a mean age of 49.3 years. There was a marked male preponderance with a 2.75:1 male-to-female ratio, and the most common primary site was the larynx (40%). the maximum number of patients presented to the outpatient department when the primary was at the stage of T3 in the case of laryngeal tumors and T2 in the case of oral cavity tumors. When comparing the results of clinical examinations to histopathology, there were 30 clinically N0 necks, while 13 cases were found to be histopathologically positive. So, true positives were 17 (56.66%), and false negatives were 13 (43.33%). Out of 13 histopathologically proven positive necks, CT could diagnose metastasis in 7 cases, which showed a statistically significant correlation between CT scan and histopathology (p value 0.01). Out of 13 histopathologically proven positive necks, MRI could diagnose metastasis in 6 cases, which showed a statistically significant correlation between CT scan and histopathology (p value 0.02). Conclusion: This study concludes that palpation alone was an inaccurate technique for assessment of the neck. Computed tomography and magnetic resonance imaging had a higher accuracy for diagnosing metastatic disease than clinical examination. Both have comparable efficacy in detecting occult metastasis in the neck. Histopathological confirmation is indispensable in view of the low sensitivity of both modalities.