Background: Traditional imaging techniques have limited efficacy in detecting occult cervical lymph node (LN) metastases in head and neck squamous cell carcinoma (HNSCC). Positron emission tomography/computed tomography (PET-CT) has demonstrated potential for assessing HNSCC, but the literature on its efficacy for detecting cervical LN metastases is scarce and exhibits varied outcomes, hindering comparisons. Aim: To compare the efficacy of CT, MRI, PET-CT, and US for detecting LN metastasis in HNSCC with clinically negative neck lymph nodes. Methods: A systematic search was performed using Web of Science, PubMed, Scopus, Embase, and Cochrane databases. Studies comparing CT, MRI, PET-CT, or US to detect cervical metastases in HNSCC were identified. The quality of the studies was assessed using the QUADAS-2 instrument. The positive likelihood ratios (+LR) and negative likelihood ratios (−LR), sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR), with 95% confidence intervals (C.I.), were calculated. Analysis was stratified according to lymph node and patient basis. Results: Fifty-seven studies yielded 3791 patients. At the patient level, PET-CT exhibited the highest diagnostic performance, with a SEN of 74.5% (95% C.I.: 65.4–81.8%) and SPE of 83.6% (95% C.I.: 77.2–88.5%). PET-CT also demonstrated the highest +LR of 4.303 (95% C.I.: 3.082–6.008) and the lowest −LR of 0.249 (95% C.I.: 0.168–0.370), resulting in the highest DOR of 15.487 (95% C.I.: 8.973–26.730). In the evaluation of diagnostic parameters for various imaging modalities on node-based analysis results, MRI exhibited the highest SEN at 77.4%, and PET demonstrated the highest SPE at 96.6% (95% C.I.: 94.4–98%). PET-CT achieved the highest DOR at 24.353 (95% C.I.: 10.949–54.166). Conclusions: PET-CT outperformed other imaging modalities across the majority of studied metrics concerning LN metastasis detection in HNSCC.

The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) stratifies patients with thyroid nodules for further evaluation. We evaluated the accuracy of this risk stratification and compared it with that of fine-needle aspiration cytology (FNAC) and final pathology. The nodules (n = 381) of 329 patients (mean age, 45.5 y; 251 female) who underwent thyroid surgery from January 2021 to September 2023 were retrospectively analyzed for the ACR TI-RADS, FNAC, and final pathology results. The nodules were categorized according to risk of malignancy as 75.9% ACR TI-RADS 5, 72.6% ACR TI-RADS 4, 38.9% ACR TI-RADS 3, and 33.3% ACR TI-RADS 2. Considering ACR TI-RADS 5 and 4 as high-risk categories, the sensitivity, specificity, positive-predictive value, and negative-predictive value of the ACR TI-RADS categories were 77.9%, 57.3%, 73.8%, and 62.8%, respectively. With both ACR TI-RADS and FNAC high-risk categories combined, the sensitivity and specificity improved to 82.4% and 58.6%, respectively. The ACR TI-RADS score effectively predicts malignancy in higher-risk categories; however, some malignant cases were found within lower-risk categories, implying the need for careful utilization of this system. Combining high-risk ACR TI-RADS and FNAC results improves the diagnostic accuracy of thyroid nodules. Confirmation from further prospective studies is required.