Background Ultrasound of the neck with fine needle aspiration (US‐FNA) of suspicious lymph nodes has potential advantages over other radiologic techniques as a screening method for the N0 neck in head and neck cancer. Methods Twenty‐five patients with head and neck cancer who underwent both US of the neck with FNA of any suspicious lymph nodes and neck computed tomography (CT) prior to elective neck dissection were studied. The majority of patients had squamous cell carcinoma (SCC) of the upper aerodigestive tract. Histopathologic results of the neck specimens were compared with each screening technique (palpation, US, US‐FNA, CT). Results Computed tomography (87.9%) and US‐FNA (84.9%) had similar overall accuracy in terms of screening the N0 neck in our study and were superior to palpation (69.7%) and US alone (72.7%). Specificity was 100% for both CT and US‐FNA, with a sensitivity of 60% for CT and 50% for US‐FNA. Ultrasound‐FNA and CT showed false‐negative examinations on virtually the same cases. Conclusions Overall, US‐FNA was comparable to CT in screening the N0 neck in our study. The choice of which modality to employ for imaging the clinically negative neck depends on a number of factors, including the location and clinical extent of the primary tumor as well as the experience and preference of the head and neck surgeon and radiologist. © 1997 John Wiley & Sons, Inc. Head Neck 19: 604–610, 1997.

Local and regional recurrence is the principal reason for treatment failure in squamous cell carcinoma (SCC) of the head and neck. The conventional method of evaluating surgical margins for cellular atypia does not always predict risk of local recurrence accurately. Immunostaining of surgical margins for tumor markers may provide a more precise evaluation of risk of local recurrence. Paraffin-embedded tissue blocks of surgical margins from 24 patients with oral cavity and oropharyngeal squamous cell carcinoma were immunostained for p53 protein. Fifty-eight percent of the patients had at least one margin stain positive for p53, including eight often patients whose SCC recurred locally. The sample odds ratio test predicted a 5.333 times higher chance of local recurrence with at least one p53 positive surgical margin. The implications of these results for patient management and further investigations will be discussed.