To the Editor.—I enjoyed reading the well-executed and well-presented study, "Metastatic Neck Disease," by Feinmesser et al1 in the December issue of the Archives. Furthermore, I found the editor's comments to be pertinent. However, because this article contradicts both my published articles and my current work, I wish to present several comments.
My initial study, published in the July 1984 issue of the Archives,2 showed that 39% of patients with clinically negative necks were found to have occult metastatic nodal disease at surgery. Additionally, my study showed that evaluation by preoperative computed tomographic scans reduced the incidence of undetected occult disease to 11%, while the Feinmesser study found their scans to be of no value.
In a commentary published in the July 1984 issue of the Archives, Cantrell3 questioned the justification of preoperative computed tomographic scans in view of the added cost. We clarified several issues in
FRIEDMAN M. Metastatic Neck Disease. Arch Otolaryngol Head Neck Surg. 1988;114(7):808. doi:10.1001/archotol.1988.01860190112037
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