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

Abstract

Objectives: To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC).Study Design: Retrospective study. Methods: Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologistspecific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature.Results: Thirty-two (44%) patients had ENE-positive lymph nodes. The presence of irregular margins (OR A = 12.3, 95% confidence interval [CI] A = 2.3-65.9; OR B = 7.0, 95% CI B = 1.4-36.3) and absence of perinodal fat plane (OR A = 6.8, 95% CI A = 2.0-23.3; OR B = 14.2, 95% CI B = 1.7-120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (Sn A = 45%, Sp A = 94%, AUC A = 69%, PPV A = 82%, NPV A = 73%; Sn B = 28%, Sp B = 95%, AUC B = 61%, PPV B = 80%, NPV B = 64%). Absence of perinodal fat plane was most sensitive for ENE (Sn A = 87%, Sp A = 50%, AUC A = 69%, PPV A = 59%, NPV A = 62%; Sn B = 96%, Sp B = 34%, AUC B = 65%, PPV B = 53%, NPV B = 63%).Conclusions: Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively.

Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

“…The area under the receiver operating characteristics curve for diagnosing ENE and lymph node metastases was 0.91 (95% CI = 0.85-0.97)-ENE of lymph node metastases could be predicted with a sensitivity of 88% and specificity of 85% (22). The diagnosis of ENE by means of CT was additionally the subject of the recently published work by Faraji et al (15). Seventy-three patients with HPV-positive OPSCC treated by primary surgery and neck dissection were reviewed for the presence of seven defined criteria of CT imaging (15).…”

“…The diagnosis of ENE by means of CT was additionally the subject of the recently published work by Faraji et al (15). Seventy-three patients with HPV-positive OPSCC treated by primary surgery and neck dissection were reviewed for the presence of seven defined criteria of CT imaging (15). The pretreatment CT scans were evaluated by two radiologists who were blinded to the pathologic ENE results (15).…”

“…Seventy-three patients with HPV-positive OPSCC treated by primary surgery and neck dissection were reviewed for the presence of seven defined criteria of CT imaging (15). The pretreatment CT scans were evaluated by two radiologists who were blinded to the pathologic ENE results (15). In the evaluations, the presence of irregular nodal margins (highest specificity of 94% for examiner A and 95% for examiner B) and the absence of perinodal fatty tissue (highest sensitivity of 87% for examiner A and 96% for examiner B) showed a significant association with ENE (15).…”

“…Clinical diagnosis of ENE by ultrasound, with a sensitivity of 78.6% and specificity of 81.8%, achieved slightly better results than CT or MRI ( 1 , 14 ). With regard to diagnosing ENE by contrast-enhanced CT imaging, the values quoted in the literature according to Faraji et al and others range from 75 to 86% for the accuracy of predicting pathologic ENE, from 65 to 90% for sensitivity and 73–91% for the specificity of the imaging method ( 12 , 15 – 21 ). As clinical diagnosis of ENE, for example, does not differentiate between microscopic and macroscopic ENE so far, the data of patient collectives with primary surgery and collectives with primary radiotherapy are not readily comparable.…”

Prognostic Value of Nodal Matting on MRI in Nasopharyngeal Carcinoma Patients

“…9,10 Another potentially useful lymph node feature is nodal matting, which is defined as three or more lymph nodes abutting together with the absence of intervening fat planes. 11,12 It can be evaluated by sonography, computed tomography (CT), or magnetic resonance imaging (MRI), [11][12][13][14] and has been shown to be an important prognostic factor for some cancers. 11,[15][16][17] Sivridis et al 15 found that nodal matting and nodal necrosis were associated with poor prognosis, independent of N-stage in node-positive breast carcinomas.…”