Accuracy of Computed Tomography in the Prediction of Extracapsular Spread of Lymph Node Metastases in Squamous Cell Carcinoma of the Head and Neck

Chai, Raymond L.; Rath, Tanya J.; Johnson, Jonas T.; Ferris, Robert L.; Kubicek, Gregory J.; Duvvuri, Umamaheswar; Branstetter, Barton F.

doi:10.1001/jamaoto.2013.4491

Cited by 87 publications

(71 citation statements)

References 39 publications

(31 reference statements)

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“…In a second recent study, Chai et al 20 concluded that "radiologic findings suggestive of ECS should not be relied on for treatment planning in squamous cell carcinoma of the head and neck." Chai et al 20 used a 5-point scale for the evaluation of radiographically determined ECS, included a wider range of primary tumors, and had 2 different observers with specificities of 54% and 84%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma

Aiken¹,

Poliashenko

Beitler³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The increasing impact of diagnosing extracapsular spread by using imaging, especially in patients with oropharyngeal squamous cell carcinoma, highlights the need to rigorously evaluate the diagnostic accuracy of imaging. Previous analysis suggested 62.5%-80.9% sensitivity and 60%-72.7% specificity. Our goals were to evaluate the accuracy of imaging in diagnosing extracapsular spread in a cohort of patients with oral cavity squamous cell carcinoma (pathologic confirmation of extracapsular spread routinely available), as a proxy for oropharyngeal squamous cell carcinoma, and to independently assess the reliability of imaging features (radiographic lymph node necrosis, irregular borders/stranding, gross invasion, and/or node size) in predicting pathologically proven extracapsular spread.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma

Aiken¹,

Poliashenko

Beitler³

et al. 2015

AJNR Am J Neuroradiol

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“…Preoperative imaging had a PPV for predicting ENE > 2 mm of only 44-55%, which is too low for treatment decision making. We and others [10,18] have found the present techniques inadequate for identifying ENE in patients with HPV-associated OPSCC.…”

Section: Discussionmentioning

confidence: 62%

Radiographic Imaging Does Not Reliably Predict Macroscopic Extranodal Extension in Human Papilloma Virus-Associated Oropharyngeal Cancer

Patel

Hudgins

Beitler

et al. 2018

ORL

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Background: Radiographic concern for lymphatic extranodal extension (ENE) impacts upfront management decisions for patients with human papilloma virus (HPV) oropharyngeal squamous cell carcinoma (OPSCC). Therefore, we set out to evaluate the accuracy of preoperative contrast-enhanced computed tomography (CECT) to predict major ENE (> 2 mm). Methods: Twenty-seven consecutive patients with HPV-associated OPSCC who presented at our institutional multidisciplinary tumor board were staged radiographically with positron emission tomography (PET/CT) and CECT, and underwent primary transoral robotic resection and neck dissection. CECT imaging results were correlated with pathologic ENE (pENE). Results: CECT specificity for all pENE was 69 and 75% for radiologist 1 and 2, respectively. For pENE > 2 mm, the sensitivities were 88 and 100%, but specificities were 52.6 and 63.2%. Positive predictive values (PPV) were 43.8 and 53.3%; negative predictive values were 90.9 and 100%. On logistic regression analysis, only size ≥3 cm (OR 4.7–5.4, p < 0.02, 95% CI 1.3–44.0) demonstrated significant correlation with major ENE > 2 mm. Conclusions: Preoperative imaging for HPV-associated OPSCC had a PPV for pENE > 2 mm of 44–55%, based on any interruption in the capsule or invasion into the perinodal fat. The PPV is low and equipoise in treatment decision making for patients with HPV-associated OPSCC may require other imaging characteristics.

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“…We did not evaluate matted nodes, given previously demonstrated poor interobserver agreement for this parameter. 20 The negative predictive value of rECS on CT is poor; however, rECS on CT as evidenced by adjacent structure invasion has a good positive predictive value. [20][21][22][23] We found, in multivariate analysis, that rECS with invasion of surrounding soft tissues was an independent predictor of TF and that rECS correlated significantly with solid lymph node metastasis.…”

Section: Discussionmentioning

confidence: 95%

“…20 The negative predictive value of rECS on CT is poor; however, rECS on CT as evidenced by adjacent structure invasion has a good positive predictive value. [20][21][22][23] We found, in multivariate analysis, that rECS with invasion of surrounding soft tissues was an independent predictor of TF and that rECS correlated significantly with solid lymph node metastasis. Recently Liu et al 24 did not find rECS to be an independent predictor of TF in a subset of patients with HPV-related OPSCC, though there was a trend toward worse survival in this group.…”

Section: Discussionmentioning

confidence: 95%

Solid Lymph Nodes as an Imaging Biomarker for Risk Stratification in Human Papillomavirus–Related Oropharyngeal Squamous Cell Carcinoma

Rath¹,

Narayanan²,

Hughes³

et al. 2017

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Human papillomavirus-related oropharyngeal squamous cell carcinoma is associated with cystic lymph nodes on CT and has a favorable prognosis. A subset of patients with aggressive disease experience treatment failure. Our aim was to determine whether the extent of cystic lymph node burden on staging CT can serve as an imaging biomarker to predict treatment failure in human papillomavirus-related oropharyngeal squamous cell carcinoma.

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Accuracy of Computed Tomography in the Prediction of Extracapsular Spread of Lymph Node Metastases in Squamous Cell Carcinoma of the Head and Neck

Abstract: Computed tomography cannot be used to reliably determine the presence of pathologic ECS. Radiologic findings suggestive of ECS should not be relied on for treatment planning in squamous cell carcinoma of the head and neck.

Cited by 87 publications

References 39 publications

Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma

Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma

Radiographic Imaging Does Not Reliably Predict Macroscopic Extranodal Extension in Human Papilloma Virus-Associated Oropharyngeal Cancer

Solid Lymph Nodes as an Imaging Biomarker for Risk Stratification in Human Papillomavirus–Related Oropharyngeal Squamous Cell Carcinoma

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