Metastatic squamous carcinoma in the neck: an anatomical and physiological study using CT and SPECT 99Tcm (V) DMSA.

Technetium-99m (99Tcm) (V) dimercaptosuccinic acid (DMSA) is a new tumour imaging agent that has been used to image squamous cell carcinoma (SCC) of the head and neck. This study has been undertaken to compare clinical examination with computed tomography (CT) (anatomical) and SPECT 99Tcm (V) DMSA (physiological) imaging in the evaluation of metastatic SCC of the neck. Twenty-five patients with head and neck cancer were studied. Computed tomography was as sensitive but more accurate than clinical examination in predicting the presence of cancer. SPECT 99Tcm (V) DMSA was inferior to both techniques in identifying metastatic disease. There is no role for SPECT 99Tcm (V) DMSA imaging in the management of patients with SCC metastatic to the neck. Combined imaging with CT offered no advantages over anatomical imaging with CT alone. There is no role for CT in the routine evaluation of the clinically N0 neck and the role of CT of the neck in the management of patients with metastatic SCC is discussed.