Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma

Abstract

The sensitivity and specificity of radiological detection of extranodal spread from head and neck squamous cell carcinoma is not well reported in the literature. Accuracy of reporting improves in the hands of experienced head and neck radiologists. This finding has clinical implications for surgical planning and adjuvant therapy requirements.

Radiographic extracapsular extension and treatment outcomes in locally advanced oropharyngeal carcinoma

“…Given the lack of a defined set of criteria among studies and the varying clinical experience and training of readers in the identification of rECE, caution should be taken in comparing studies for specificity or sensitivity and generalizing these results to the general community. In 1 series with 149 patients, 2 radiologists at the same institution reading the same images were found to have rECE to pECE sensitivities of 66% and 80%, respectively, demonstrating that even within a single institution there can be varying interpretations . In our study, a single radiologist (P.S.…”

“…Because most of the patients in our study did not undergo surgery, our pathologic cases were small in number, and we could not reliably address the accuracy with which rECE predicted pECE. Multiple single‐institution studies have demonstrated ranges from 65% to 90% for sensitivity and 73% to 91% for specificity of rECE on CT in predicting pECE, although they are difficult to compare as results are subject to physician experience and scan quality . In our subset analysis, sensitivity and specificity were slightly lower, likely because of random error introduced by the small number of patients who underwent surgery ( n = 25).…”

“…The presence of radiographic ECE (rECE) is assessed on pretreatment, cancer staging workup with CT imaging as the standard for radiographic diagnosis with established criteria . There is evidence to suggest that rECE has good sensitivity and specificity in predicting pECE, although the series have generally been small, limited to single institutions, and varied in radiographic methodology . Regardless of its correlation to pECE, the independent prognostic significance of rECE itself has not been studied and would be useful in guiding clinical management both before surgery and for those who undergo definitive CCRT.…”

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

“…In the past 20 years, we can identify only 1 study in the English literature that has been performed to specifically assess the accuracy of CT in diagnosing ECS. In 2009, Souter et al 14 evaluated 149 neck dissections with CT image thickness between 3 and 5 mm. Iodinated contrast medium was not consistently used for all imaging studies.…”

“…Two studies 12,13 from the early 1990s are contradictory, revealing sensitivities for the detection of ECS from 60% to almost 100%. More recent studies 14,15 have demonstrated sensitivities between 65%…”