In head and neck squamous cell carcinoma (HNSCC) the lymph node status of the neck is the most important prognosticator. A clinically negative neck (N0) at palpation is at risk of harboring occult metastases. Because of the low morbidity of an elective neck dissection, this policy is widely accepted if the risk of occult metastases is estimated to be higher than 20%. Although both computed tomography (CT) and magnetic resonance imaging (MRI) of the neck have been found to be superior to palpation in detecting cervical metastases, these modalities still have a relatively low accuracy for the N0 neck. Furthermore, CT and MRI have the disadvantages of being expensive and not readily accessible for repeated use in follow-up of patients. In contrast, ultrasound guided fine needle aspiration cytology (USgFNAC) has a high sensitivity and specificity and moreover, is a quick, safe and cheaper technique compared to CT and MRI. Selection of the correct node for aspiration is very important and based on known patterns of lymphatic spread as well as on size and site of lymph nodes. However, these criteria are prone to errors, what still causes false-negative cases at USgFNAC. Improvement of USgFNAC may be possible with better selection of lymph nodes at risk, i.e.selective aspiration of the sentinel node (SN). The aim of this study is to investigate whether the combined use of a SN procedure and USgFNAC of the lymph nodes at risk can improve staging of head and neck cancer patients.