A 62-year-old male has a clinically N2b neck (multiple ipsilateral nodes, largest 3.5 cm, no extranodal extension on imaging). Following concurrent chemoradiotherapy, residual lymphadenopathy persists at 10 weeks. What is the appropriate next step?

• A Immediate salvage neck dissection
• B Repeat PET-CT at 6 months
• C Fine needle aspiration of the residual node
• D PET-CT at 12 weeks post-treatment completion ✓

Explanation

Current evidence-based guidelines recommend PET-CT at 12 weeks post-completion of chemoradiotherapy to assess neck response, as earlier imaging can have false-positive results due to inflammation and post-treatment changes. A negative PET-CT at 12 weeks has high negative predictive value (>95%) for neck disease, obviating the need for planned neck dissection. Salvage neck dissection is reserved for PET-confirmed persistent disease. FNAC alone is not reliable for post-treatment assessment.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.