Objectives: Comparing the accuracy of USS and USS + FNAC as investigative modalities of staging neck disease in head and neck SCC.

Design: Retrospective cohort study.

Method: A retrospective cohort study carried out at UCLH head and neck unit over 4 years between 2006 and 2009. Inclusion criteria were: all cases of histologically proven head and neck SCC cases having metastatic neck nodal disease. These patients had radiological staging with USS alone, or USS and FNAC in addition to standard imaging modalities followed by neck dissection at UCLH. Data was retrieved from case notes. The reports were correlated to evaluate efficacy accuracy of pre-operative USS alone, and USS with FNAC as a staging tool with histologically proven neck disease.

Results: USS group N = 132. 132 USS reports with positive nodal disease looked at. The sensitivity was 92, the specificity 71% was the positive predictive value was 88%, the negative predictive value was 81%, and the accuracy was 86%. USS + FNAC group N = 74. The sensitivity was 92% and specificity was 100%. USS FNAC for the post RT subgroup was 100% accurate. With 100% sensitivity and specificity.

Conclusion: USS + FNAC is a highly accurate method of staging neck disease and would be a less capital intensive to incorporate into staging protocols in the current economically challenging situation.