Radiologic Criteria of Retropharyngeal Lymph Node Metastasis in Nasopharyngeal Carcinoma Treated with Radiation Therapy

Zhang, Guoyi; Liu, Lizhi; Wei, Weihong; Deng, Yanming; Li, Yizhuo; Liu, Xue Wen

doi:10.1148/radiol.10090289

Cited by 83 publications

(93 citation statements)

References 26 publications

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“…In a previous study, a minimal axial diameter of 6 mm or larger (with an accuracy of 87.5%) was reported to be the best size criterion for diagnosing RLN metastases. 6 In our study, the threshold short-axis diameter was 4.5 mm, where sensitivity, specificity and accuracy were 76.0%, 76.5% and 83.8%, respectively. The ability to define a smaller threshold short-axis diameter that more accurately detects RLN may be owing to better tissue resolution with 3.0-T MRI than 1.5 T MRI used in previous studies.…”

Section: Diagnosis Of Rln Metastasis With Dwimentioning

confidence: 51%

“…A RLN was considered to be positive for malignant involvement if, on the follow-up MRI, it had significantly decreased in size and was undetectable or it showed stability in size but progressed. 6 If the RLN was still detectable after RT but had decreased in size by .30%, it was considered to be a partial resolution, 13 and analysis continued until diagnosis of the node could be made. If a node showed stability in size, but T2WI and T1WI contrast enhancements were significantly reduced, a positive RLN was still diagnosed.…”

Section: Treatmentmentioning

confidence: 99%

“…A RLN was considered to be negative for malignant involvement, if it showed stability in size and the patient remained disease free. 6 Nodes were excluded from the study if a diagnosis could not be made by the completion of the follow-up.…”

Section: Treatmentmentioning

confidence: 99%

“…By contrast, the RLN was considered to be negative for malignant involvement if it showed stability in size after the completion of RT, and the patient remained disease free during the follow-up. 6,21,22 In addition, a detailed approach for diagnosis of nodes where partial resolution had occurred was presented. The node was considered to be positive if it gradually decreased in size or progressed on subsequent MRI.…”

Section: Diagnosis Of Rln Metastasis With Dwimentioning

confidence: 99%

“…A minimal axial diameter of $6 mm is the main diagnostic parameter currently used to differentiate metastatic from non-metastatic lesions, but the accuracy of the diagnosis is 87.5%. 6 Adding a functional component to imaging, such as diffusion-weighted imaging (DWI), has become increasingly crucial in the assessment of malignant tumours. DWI is a non-invasive characterization of diverse tissues based on water diffusion properties.…”

Section: Introductionmentioning

confidence: 99%

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Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma

Xw²,

Zj³

et al. 2015

Dentomaxillofacial Radiology

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Objectives: To evaluate the diagnostic value of diffusion-weighted MRI for differentiating metastatic from non-metastatic retropharyngeal lymph nodes (RLNs) in patients with nasopharyngeal carcinoma (NPC). Methods: Untreated patients with NPC (n 5 145) were scanned with both morphological MRI and diffusion-weighted imaging (DWI). RLNs (n 5 335) were classified as metastatic on the basis of response to therapy as assessed on follow-up MRI. Morphological (short-and long-axial diameters) and functional [mean apparent diffusion coefficient (ADC) and minimum ADC values] parameters of the RLNs were derived from DWI and compared between metastatic and non-metastatic groups. A receiver operating characteristic curve and the area under the curve were used to evaluate the effectiveness of individual criteria and to generate threshold values to diagnose RLN metastases. Results: Statistically significant differences between metastatic and non-metastatic RLNs were found for all four parameters derived from DWI (p , 0.001). At threshold values, accuracies of the ADC-based criteria (0.938 and 0.965 for mean and minimum ADC values, respectively) were greater than that of size-based criteria (0.838 and 0.809 for short-and longaxial diameters). The minimum ADC value at the threshold of 0.89 3 10 23 mm 2 s 21 was the most effective of all parameters in differentiating metastatic from non-metastatic RLNs with the sensitivity of 95.7%, specificity of 95.1% and accuracy of 96.5%. Conclusions: DWI is feasible for differentiating metastatic RLNs from non-metastatic nodes in patients with NPC with high accuracy, and the minimum ADC derived from DWI could serve as a standard clinical marker for disease status. Dentomaxillofacial Radiology (2015Radiology ( ) 44, 20140126. doi: 10.1259 Cite this article as: Li H, Liu X-W, Geng Z-J, Wang D-L, Xie C-M. Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma. Dentomaxillofac Radiol 2015; 44: 20140126.

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Section: Diagnosis Of Rln Metastasis With Dwimentioning

confidence: 51%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Diagnosis Of Rln Metastasis With Dwimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma

Xw²,

Zj³

et al. 2015

Dentomaxillofacial Radiology

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The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer

Gunn

Debnam

Fuller

et al. 2013

Cancer

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Background We carried out this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, which have not been well established to date. Methods Our departmental database was queried for patients irradiated for OPC from 2001–2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcomes data were retrieved and analyzed. Results The cohort consisted of 981 patients. Median follow up was 69 months. The base of tongue (47%) and tonsil (46%) were the most common primary sites. The majority of patients had T1-2 primaries (64%) and 94% stage 3-4B disease. IMRT was used in 77%, and systemic therapy was delivered to 58%. The incidence of radiographic RPLN involvement was 10% and highest for pharyngeal wall (23%) and lowest for base of tongue tumors (6%). RPLN adenopathy correlated with a number of patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (p <.001 for all): local control (79% vs. 92%), nodal control (80% vs. 93%), recurrence-free (51% vs. 81%), distant metastases-free (66% vs. 89%), and overall survival (52% vs. 82%), and maintained significance for local control (p=.023), recurrence-free (p=.001), distant metastases-free (p=.003), and overall survival (p=.001) on multivariate analysis. Conclusions In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.

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Radiographic retropharyngeal lymph node involvement in HPV‐associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes

Lin

Garden

Elhalawani

et al. 2019

Cancer

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Background The objective of the current study was to characterize the incidence, pattern, and impact on oncologic outcomes of retropharyngeal lymph node (RPLN) involvement in HPV‐associated oropharyngeal cancer (OPC). Methods Data regarding patients with HPV‐associated OPC who were treated at The University of Texas MD Anderson Cancer Center with intensity‐modulated radiotherapy from 2004 through 2013 were analyzed retrospectively. RPLN status was determined by reviewing pretreatment imaging and/or reports. Outcomes analysis was restricted to patients with lymph node‐positive (+) disease. Kaplan‐Meier survival estimates were generated and survival curves were compared using the log‐rank test. Bayesian information criterion assessed model performance changes with the addition of RPLN status to current American Joint Committee on Cancer staging. Competing risk analysis compared modes of disease recurrence. Results The incidence of radiographic RPLN involvement was 9% (73 of 796 patients) and was found to vary by primary tumor site. The 5‐year rates of freedom from distant metastases (FDM) and overall survival were lower in patients with RPLN(+) status compared with those with RPLN‐negative (‐) status (84% vs 93% [P = .0327] and 74% vs 87% [P = .0078], respectively). RPLN(+) status was not found to be associated with outcomes on multivariate analysis. Bayesian information criterion analysis demonstrated that current American Joint Committee on Cancer staging was not improved with the inclusion of RPLN. Locoregional and distant disease recurrence probabilities for those patients with RPLN(+) status were 8% and 13%, respectively, compared with 10% and 6%, respectively, for those with RPLN(‐) status. RPLN(+) status portended worse 5‐year FDM in the low‐risk subgroup (smoking history of <10 pack‐years) and among patients who received concurrent chemotherapy but not induction chemotherapy. Conclusions RPLN(+) status was associated with worse overall survival and FDM on univariate but not multivariate analysis. In subgroup analyses, RPLN(+) status was associated with poorer FDM in both patients with a smoking history of <10 pack‐years and those who received concurrent chemotherapy, suggesting that RPLN(+) status could be considered an exclusion criteria in treatment deintensification efforts seeking to omit chemotherapy.

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Radiologic Criteria of Retropharyngeal Lymph Node Metastasis in Nasopharyngeal Carcinoma Treated with Radiation Therapy

Cited by 83 publications

References 26 publications

Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma

Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma

The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer

Radiographic retropharyngeal lymph node involvement in HPV‐associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes

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