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Research ArticleHead & Neck

Positive Predictive Value of Neck Imaging Reporting and Data System Categories 3 and 4 Posttreatment FDG-PET/CT in Head and Neck Squamous Cell Carcinoma

P. Wangaryattawanich, B.F. Branstetter, J.D. Ly, U. Duvvuri, D.E. Heron and T.J. Rath
American Journal of Neuroradiology June 2020, 41 (6) 1070-1075; DOI: https://doi.org/10.3174/ajnr.A6589
P. Wangaryattawanich
aFrom the Departments of Radiology (P.W., B.F.B., J.D.L.)
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B.F. Branstetter
aFrom the Departments of Radiology (P.W., B.F.B., J.D.L.)
bOtolaryngology (B.F.B., U.D., D.E.H.)
cBiomedical Informatics (B.F.B.)
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J.D. Ly
aFrom the Departments of Radiology (P.W., B.F.B., J.D.L.)
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U. Duvvuri
bOtolaryngology (B.F.B., U.D., D.E.H.)
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D.E. Heron
bOtolaryngology (B.F.B., U.D., D.E.H.)
dRadiation Oncology (D.E.H.), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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T.J. Rath
eNeuroradiology Section, Department of Radiology (T.J.R.), Mayo Clinic Hospital, Phoenix, Arizona.
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Abstract

BACKGROUND AND PURPOSE: The Neck Imaging Reporting and Data System is a standardized reporting system intended to risk stratify patients treated for head and neck squamous cell carcinoma. The purpose of this study is to investigate the positive predictive value of the Neck Imaging Reporting and Data System categories 3 and 4 on posttreatment PET/CT in patients treated definitively for head and neck squamous cell carcinoma.

MATERIALS AND METHODS: We retrospectively identified patients treated definitively for head and neck squamous cell carcinoma between 2006 and 2018. Patients whose posttreatment PET/CT scans were interpreted as Neck Imaging Reporting and Data System 3 (suspicious) or 4 (definitive recurrence) at the primary site, regional nodes, or at distant sites were included. The reference standard was histopathology or unequivocal imaging or clinical evidence of treatment failure. The positive predictive values of Neck Imaging Reporting and Data System 3 and 4 posttreatment PET/CT were calculated.

RESULTS: Seventy-two of 128 patients with posttreatment PET/CT interpreted as Neck Imaging Reporting and Data System 3 at the primary site, regional nodes, or distant sites were proved to have treatment failure at the suspicious sites, yielding an overall positive predictive value of 56% (95% CI, 48%–65%). The positive predictive values of Neck Imaging Reporting and Data System 3 by subsite were as follows: primary site, 56% (44/79); regional nodes, 65% (34/52); and distant sites, 79% (42/53). All 69 patients with posttreatment PET/CT interpreted as Neck Imaging Reporting and Data System 4 had true treatment failure, yielding a positive predictive value of 100% (95% CI, 96%–100%): primary site, 100% (28/28); regional nodes, 100% (32/32); and distant sites, 100% (29/29).

CONCLUSIONS: The positive predictive value of Neck Imaging Reporting and Data System 3 on posttreatment PET/CT is relatively low. Thus, Neck Imaging Reporting and Data System 3 findings should be confirmed with tissue sampling before instituting new salvage treatment regimens to avoid unnecessary overtreatment and its associated toxicities. Neck Imaging Reporting and Data System 4 reliably indicates recurrent disease.

ABBREVIATIONS:

AJCC
American Joint Committee on Cancer
D
distant sites
HNSCC
head and neck squamous cell carcinoma
HPV
human papillomavirus
N
regional nodes
NI-RADS
Neck Imaging Reporting and Data System
P
primary site
PPV
positive predictive value
  • © 2020 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 41 (6)
American Journal of Neuroradiology
Vol. 41, Issue 6
1 Jun 2020
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Positive Predictive Value of Neck Imaging Reporting and Data System Categories 3 and 4 Posttreatment FDG-PET/CT in Head and Neck Squamous Cell Carcinoma
P. Wangaryattawanich, B.F. Branstetter, J.D. Ly, U. Duvvuri, D.E. Heron, T.J. Rath
American Journal of Neuroradiology Jun 2020, 41 (6) 1070-1075; DOI: 10.3174/ajnr.A6589

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Positive Predictive Value of Neck Imaging Reporting and Data System Categories 3 and 4 Posttreatment FDG-PET/CT in Head and Neck Squamous Cell Carcinoma
P. Wangaryattawanich, B.F. Branstetter, J.D. Ly, U. Duvvuri, D.E. Heron, T.J. Rath
American Journal of Neuroradiology Jun 2020, 41 (6) 1070-1075; DOI: 10.3174/ajnr.A6589
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