Systematic review on ultrasonography guided FNAC in detection of regional lymph node metastasis in head and neck carcinoma

Introduction: Regional metastasis to the cervical lymph nodes is an important prognostic factor in head and neck carcinoma. The neck is generally assessed clinically, but has a low sensitivity and specificity with false negative results ranging from15%-25%. Clinically, the detection of a small lymph node of 1 cm3 or less is easily missed out which may have billions of tumour cells. Aim and objective: Review the published literature of assessment of head and neck carcinoma with/without clinically detectable regional cervical lymph nodes using USG-FNAC. Materials and method: Thirty-five published articles were retrieved, selected from indexed sites and non indexed journals for the studies on USG-FNAC in head and neck carcinoma. Two reviewers independently assessed the titles and abstracts of reports of trial identified by the electronic search. Full text hard copies were obtained for studies that appeared to fulfill the selection criteria and for studies where there was any doubt. Inter-rater agreement for study selection was measured using the kappa statistics. In case of discrepancy, the opinion of the third reviewer was sought to reach a consensus. Data were independently extracted by the reviewers and cross-checked. A standard data extraction form was used. Two reviewers assessed the methodological quality of each included study using the QUality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Conclusion: USG-FNAC has been found to be an accurate investigation for the cervical lymph node metastasis in patients with head and neck cancer. Additional information gained from USG examination and FNAC is valuable in diagnosis and follow-up. Schlagwörter: head and neck cancer, diagnostic tool accuracy, ultrasonography guided FNAC, QUADAS