Among patients with high-risk cutaneous squamous cell carcinoma (SCC) of the head and neck, baseline ultrasonography is more sensitive for detection of lymph node metastases than clinical examination alone, according to a study published online Dec. 29 in JAMA Dermatology.

Selin Tokez, from the University Medical Center Rotterdam in the Netherlands, and colleagues examined the diagnostic accuracy of clinical examination and baseline ultrasonography for detection of metastases in a study conducted among 233 patients with 246 high-risk cutaneous SCC tumors of the head and neck.

The researchers found that 20 metastases were cytologically confirmed at baseline, and during six months of follow-up, two metastases were detected, yielding a metastasis rate of 9 percent. The sensitivity and specificity of clinical examination were 50 and 96 percent, respectively. The positive predictive value (PPV) was 55 percent, and the negative predictive value (NPV) was 95 percent. Ultrasonography had a sensitivity and specificity of 91 and 78 percent, respectively, in the total cohort, with a PPV and NPV of 29 and 99 percent, respectively. Among patients with negative results at baseline clinical examination, ultrasonography detected nine of 11 metastases, with sensitivity, specificity, PPV, and NPV of 82, 79, 17, and 99 percent, respectively.

"Future studies are needed to identify the specific populations with cutaneous SCC who would most benefit from the addition of baseline ultrasonographic evaluation to detect occult metastatic disease," the authors write.

One author disclosed financial ties to Sanofi.

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