Computed tomography detection of extracapsular spread of squamous cell carcinoma of the head and neck in metastatic cervical lymph nodes

Abstract

Background and purpose In patients with squamous cell carcinoma of the head and neck (HNSCC), extracapsular spread (ECS) of metastases in cervical lymph nodes affects prognosis and therapy. We assessed the accuracy of intravenous contrast-enhanced computed tomography (CT) and the utility of imaging criteria for preoperative detection of ECS in metastatic cervical lymph nodes in patients with HNSCC. Materials and methods Preoperative intravenous contrast-enhanced neck CT images of 93 patients with histopathological HNSCC metastatic nodes were retrospectively assessed by two neuroradiologists for ECS status and ECS imaging criteria. Radiological assessments were compared with histopathological assessments of neck dissection specimens, and interobserver agreement of ECS status and ECS imaging criteria were measured. Results Sensitivity, specificity, positive predictive value, and accuracy for overall ECS assessment were 57%, 81%, 82% and 67% for observer 1, and 66%, 76%, 80% and 70% for observer 2, respectively. Correlating three or more ECS imaging criteria with histopathological ECS increased specificity and positive predictive value, but decreased sensitivity and accuracy. Interobserver agreement for overall ECS assessment demonstrated a kappa of 0.59. Central necrosis had the highest kappa of 0.74. Conclusion CT has moderate specificity for ECS assessment in HNSCC metastatic cervical nodes. Identifying three or more ECS imaging criteria raises specificity and positive predictive value, therefore preoperative identification of multiple criteria may be clinically useful. Interobserver agreement is moderate for overall ECS assessment, substantial for central necrosis. Other ECS CT criteria had moderate agreement at best and therefore should not be used individually as criteria for detecting ECS by CT.

Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma

“…Multiple studies have investigated the accuracy of CT in identifying ECS, (Table ) however, only a limited number of studies have focused on ECS in P16 + OPSCC which has implications for accuracy due to the differing clinical and radiological features, and for how this knowledge is applied to clinical practice as other cancers, such as cutaneous SCC, are readily amenable to resection. Geltzeiler et al .…”

Computed tomography performance in predicting extranodal extension in HPV‐positive oropharynx cancer

“…Radiologic predictors of ENE in HNSCC have been a topic of continued investigation. In aggregate, the literature ranges from 65% to 90% for sensitivity, 73% to 91% for specificity, and 75% to 86% for accuracy in predicting pathologic ENE using contrast‐enhanced computed tomography (cCT) . These studies were performed using HNSCC from heterogenous or undefined anatomic subsites and did not account for the role of HPV status.…”

Molecular prognosticators in clinically and pathologically distinct cohorts of head and neck squamous cell carcinoma—A meta-analysis approach

“…Additionally, Human papilloma virus (HPV) -associated etiology is an increasingly evident prognostic factor; oropharynx being the most commonly associated site [10] [11] [12]. Among pathological parameters, nodal metastasis is a significant prognosticator in HNSCC; the primary tumor site, presence of PNI, extra-capsular spread (ECS), being additional contributing factors [2][3][4]13,14]. PNI is a factor that can determine lymph node involvement, recurrence, disease-free and overall survival necessitating appropriate treatment management if susceptibility is detected.…”