To evaluate the effectiveness of ultrasonography and computed tomography in detecting nodal metastases in patients with high-risk cutaneous squamous cell carcinoma compared to physical examination.
Key Findings:
Ultrasonography had the highest sensitivity at nearly 64%, followed by CT at 55%, compared to just over 8% for physical examination.
Both imaging modalities showed similar overall diagnostic accuracy and near perfect agreement with each other.
Specificity was over 95% for ultrasonography and CT, and 99% for physical examination.
In immunocompetent patients, ultrasonography and CT detected 100% of nodal metastases, while sensitivity dropped significantly in immunosuppressed patients.
Interpretation:
Ultrasonography and CT are superior to physical examination for detecting nodal metastases in high-risk cSCC patients, but their effectiveness is reduced in immunosuppressed individuals.
Limitations:
Small number of metastatic events.
Variability in timing between diagnostic tests.
Potential intercenter and interobserver differences.
Short follow-up may have affected detection of later-emerging metastases.
Conclusion:
Imaging should be utilized for baseline nodal staging in high-risk cSCC patients, with consideration of immune status affecting performance.
