Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning

Hiyama, Takashi; Kuno, Hirofumi; Nagaki, Takahiko; Koike, Sekiya; Oda, Shioto; Fujii, Satoshi; Hayashi, Ryuichi; Kobayashi, Tatsushi

doi:10.1007/s11604-020-00929-1

Cited by 10 publications

(4 citation statements)

References 45 publications

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“…Thus, currently, diagnosis requires histological examination of the lymph nodes by neck dissection, although radiological evidence alone may be supportive albeit insufficient for detecting ENE [ 14 ]. Therefore, radiologically unclear or ambiguous extracapsular spread may not contribute to an accurate diagnosis, and some patients may undergo treatment or overtreatment for ENE [ 15 , 16 ]. However, currently, no histopathological predictors that support cENE detection are available.…”

Section: Introductionmentioning

confidence: 99%

Novel pathological predictive factors for extranodal extension in oral squamous cell carcinoma: a retrospective cohort study based on tumor budding, desmoplastic reaction, tumor-infiltrating lymphocytes, and depth of invasion

et al. 2022

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Background Extranodal extension (ENE) is a poor prognostic factor for oral squamous cell carcinoma (OSCC). Identifying ENE by clinical and/or radiological examination is difficult, thereby leading to unnecessary neck dissections. Currently, no definitive predictors are available for ENE. Thus, we aimed to determine the histological predictors of ENE by routine histopathological examination using biopsy and surgically resected specimens. Methods This retrospective study included 186 surgically resected OSCC and 83 matched biopsy specimens. Clinical features associated with the tumor microenvironment, including desmoplastic reaction (DR), tumor budding (TB), and tumor-infiltrating lymphocytes (TILs), were evaluated using hematoxylin and eosin-stained primary OSCC and neck dissection specimens. These histological features were divided into two groups: DR-immature (DR-I) and DR-mature (DR-M); TB-high (TB-H) and TB-low (TB-L); and TILs-low (TILs-L) and TILs-high (TILs-H). Clinical depth of invasion (cDOI) and pathological DOI (pDOI) were adapted for biopsies and resections, respectively; DOI was evaluated as DOI > 10 mm and DOI ≤ 10 mm. The clinicopathological relationships between these histopathological features and ENE and the independent risk factors for ENE were analyzed. The histological predictors of ENE were evaluated. Results The histological status of DR, TILs, and TB present in biopsy and resection specimens showed high accuracy with that of ENE. DR-I, TILs-L, and TB-H were significantly associated with lymph node metastasis, cDOI, and pDOI. Bivariate and multivariate analyses revealed that TB-H and pDOI > 10 mm in resections were independent factors for the presence of ENE (ENE +). The combination of TB-H/pDOI > 10 mm in resection specimens showed high specificity (91%) and accuracy (83%) regarding ENE + . Although there proved to be no independent factors in biopsies, DR-I and TILs-L were significantly associated with ENE + (p < 0.001). The combination of DR-I/TILs-L/cDOI > 10 mm in biopsies exhibited high sensitivity and specificity with ENE + (70% and 77%, respectively, p < 0.001). These histological predictors could detect even minor ENE (< 2 mm). Conclusions The tumor microenvironment status in primary OSCC was significantly associated with that of ENE, and TB-H was an independent risk factor for ENE. The histological status of DR-I/TILs-L/cDOI > 10 mm in biopsy specimens and TB-H/pDOI > 10 mm in resection specimens is a useful predictor of ENE.

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Section: Introductionmentioning

confidence: 99%

Novel pathological predictive factors for extranodal extension in oral squamous cell carcinoma: a retrospective cohort study based on tumor budding, desmoplastic reaction, tumor-infiltrating lymphocytes, and depth of invasion

et al. 2022

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“…Although macroscopic extranodal extension is well predicted preoperatively, microscopic extranodal extension is often noted on final pathology . Location of positive nodes has implications for dose and location of adjuvant radiotherapy delivered, particularly in cases with extranodal extension, which is difficult to predict intraoperatively . As such, radiographic/anatomic labeling of neck levels has been standardized by the committee on neck dissection of the AHNS, and adherence to standards is urged .…”

Section: Resultsmentioning

confidence: 99%

“…66 Location of positive nodes has implications for dose and location of adjuvant radiotherapy delivered, particularly in cases with extranodal extension, which is difficult to predict intraoperatively. 67,68 As such, radiographic/anatomic labeling of neck levels has been standardized by the committee on neck dissection of the AHNS, and adherence to standards is urged. 69,70 Orientation of the neck specimen is important.…”

Section: Posttreatment Surveillancementioning

confidence: 99%

Oral Cavity Cancer Surgical and Nodal Management

Eskander,

Dziegielewski,

Patel

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceLymph node metastases from oral cavity cancers are seen frequently, and there is still inconsistency, and occasional controversies, regarding the surgical management of the neck in patients with oral cancer. This review is intended to offer a surgically focused discussion of the current recommendations regarding management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma while balancing surgical risk and oncologic outcome.ObservationsThe surgical management of the neck for oral cavity cancer has been robustly studied, as evidenced by substantial existing literature surrounding the topic. Prior published investigations have provided a sound foundation on which data-driven treatment algorithms can generally be recommended.ConclusionsExisting literature suggests that patients with oral cavity cancer should be fully staged preoperatively, and most patients should receive a neck dissection even when clinically N0. Quality standards supported by the literature include separation of each level during specimen handling and lymph node yield of 18 or more nodes. Sentinel lymph node biopsy can be considered in select tumors and within a well-trained multidisciplinary team.

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“…In this respect, we advocate that radiology reports use a standardized lexicon for the level of certainty in rENE declaration. 15 Guidelines on how to assess rENE in diagnostic imaging are sparse: Hiyama et al 17 provided an overview on how to recognize rENE on diagnostic imaging with a focus on the correlation with pENE in neck dissection specimen. Huang et al 1 described criteria for rENE in a recent overview in the context of a nonsurgically treated group of OPSCC, that is, without correlation to pENE.…”

Section: Measures To Augment the Reliability Of Rene Assessmentmentioning

confidence: 99%

Augmenting inter‐rater concordance of radiologic extranodal extension in HPV‐positive oropharyngeal carcinoma: A multicenter study

Hoebers

O’Sullivan

et al. 2022

Head & Neck

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Objectives To assess intra‐ and inter‐institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+ oropharyngeal carcinoma. Methods Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase‐I (20 cases) utilized each individual's a priori appreciation of the literature. Phase‐II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra‐ and inter‐institutional Kappa were calculated at >50% and >75% certainty levels, respectively. Results The Phase‐I intra‐institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter‐institutional Fleiss' kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039). The Phase‐II inter‐rater kappa was significantly higher than Phase‐I at the same certainty level (both p < 0.001). Conclusion A learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists.

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Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning

Cited by 10 publications

References 45 publications

Novel pathological predictive factors for extranodal extension in oral squamous cell carcinoma: a retrospective cohort study based on tumor budding, desmoplastic reaction, tumor-infiltrating lymphocytes, and depth of invasion

Novel pathological predictive factors for extranodal extension in oral squamous cell carcinoma: a retrospective cohort study based on tumor budding, desmoplastic reaction, tumor-infiltrating lymphocytes, and depth of invasion

Oral Cavity Cancer Surgical and Nodal Management

Augmenting inter‐rater concordance of radiologic extranodal extension in HPV‐positive oropharyngeal carcinoma: A multicenter study

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