Ultrasonography detects more SCC metastasis than clinical exams alone

Ultrasonography was better than clinical examination alone for detecting regional lymph node metastasis in high-risk cutaneous squamous cell carcinoma of the head and neck, according to a study.

“Cutaneous squamous cell carcinoma (SCC) is the second most common type of skin cancer among white individuals,” Selin Tokez, MSc, of the department of dermatology at Erasmus Medical Center Cancer Institute in Rotterdam, the Netherlands, and colleagues wrote. “Although cutaneous SCCs are generally considered to be curable with a low risk of mortality, the risk of metastasis is 1.5% to 5.2%. If lymph node metastasis is suspected during clinical examination, additional workup for regional metastasis is routinely performed.”

Researchers conducted a retrospective diagnostic cohort study of 233 patients (median age, 79.1 years; 75.5% men) with 246 high-risk cutaneous SCCs of the head and neck. All patients who received ultrasonographic testing for cutaneous SCCs of the head and neck between Jan. 1, 2015, and Dec. 31, 2017, were included.

Metastasis was confirmed by fine-needle aspiration cytologic (FNAC) biopsy in 22 tumors, of which ultrasonography correctly detected 20 (91%). Clinical examination detected 11 of the metastases (50%).

However, ultrasonography also had 9 false positive results.

“This diagnostic study found that ultrasonography was a more sensitive screening modality of the detection of regional lymph node metastasis in patients with high-risk cutaneous SCC of the head and neck compared with clinical examination alone,” the authors wrote. “However, ultrasonography also had a high rate of false positive findings, leading to unnecessary ultrasonography and FNAC procedures.”

The authors recommend further studies to determine the best use of ultrasonography in SCC metastasis detection.