Ultra sensitive.

While cutaneous squamous cell carcinoma (cSCC) is generally considered a local, relatively easily-addressed malignancy, there are high-risk variants (read: ≥T2, recurrent, or located on ear or lip) that carry noteworthy risk of nodal metastases. This Dutch retrospective look at 233 patients with 246 high-risk cSCC of the head and neck receiving both clinical exam and ultrasound of the neck, 26 (9%) had nodal mets detected. Half of these were detected on clinical exam while all but 2 were detected on ultrasound. This translates to a negative predictive value of 95% for a negative clinical exam and 99% for a negative US exam. The downside was the fairly low specificity of the US criteria used for biopsy—short axis >5-6 mm, round instead of oval shape, absence of fatty hilum, or extranodal extension—that resulted in 3.5 biopsies to diagnose 1 nodal met. | Tokez, JAMA Dermatol 2021