The aim of this project is to compare the efficacies of magnetic resonance imaging, computed tomography, and ultrasound in demonstrating nodes involved by metastatic carcinoma of the head and neck. Currently many patients without any clinical evidence of nodal disease have neck dissections or neck radiation. The false negative rate for the clinical examination is about 25% and clinicians feel that this puts the patient at too high a risk if left untreated. Imaging can lower the false negative rate to about 10% and at this level many authors have suggested the neck could be untreated. This must be verified by a large study. The three types of imaging must be compared to determine the best method of evaluation. MRI, CT, and ultrasound will be done in patients for whom the surgeon has decided neck dissection is appropriate. The imaging results and clinical examination will be compared to the pathological examination of the neck dissection. The false negative and false positive rate will be determined for various apparent nodal sizes on each modality. A long term goal of this process is to determine the pre-operative evaluation which identifies a high enough percentage of lymph node metastases that those with imaging negative necks can be followed rather than treated.
