RT Journal Article
SR Electronic
T1 Improving Imaging Diagnosis of Persistent Nodal Metastases after Definitive Therapy for Oropharyngeal Carcinoma: Specific Signs for CT and Best Performance of Combined Criteria
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A3461
A1 J.D. Hamilton
A1 S. Ahmed
A1 V.C. Sandulache
A1 S.P. Daram
A1 T.J. Ow
A1 H.D. Skinner
A1 A. Rao
A1 L.E. Ginsberg
A1 A.J. Kumar
A1 J.N. Myers
YR 2013
UL http://www.ajnr.org/content/early/2013/03/07/ajnr.A3461.abstract
AB BACKGROUND AND PURPOSE: Criteria for detection of persistent nodal metastases in treated oropharyngeal tumors are sensitive but nonspecific, leading to unnecessary nodal dissections. Developing specific imaging criteria for persistent nodal metastases could improve diagnosis while decreasing patient morbidity. MATERIALS AND METHODS: Patients with oropharyngeal squamous cell carcinoma with nodal metastases treated by definitive radiation therapy and subsequent nodal dissection were retrospectively evaluated. One hundred thirty-eight patients had pre- and posttherapy contrast-enhanced CTs evaluated by radiologists blinded to the status of pathologically proved hemineck persistent nodal metastases. Composite scoring criteria for CT, combined from individual parameters, were compared with radiologists' opinions, previous multiparameter criteria, and outcome data. RESULTS: New low-attenuation areas and a lack of size change (<20% cross sectional area) were both highly specific for persistent nodal metastases (99%; P = .0004). Extranodal disease on pretherapy imaging was moderately specific (86%; P = .001). The CSC correctly placed 29 patients in a low-risk category compared with 14 by previously reported criteria and radiologist reports. With good second-rater reliability, the CSC cutoff values stratified patients at highest risk of persistent nodal metastases, thereby improving specificity while maintaining sensitivity. CONCLUSIONS: Comparing pre- and posttherapy examinations improves specificity by discriminating focal findings and size change compared with a single time point. The CSC can categorize the risk of persistent nodal metastases more accurately than previous CT methods. This finding has the potential to improve resource use and reduce surgical morbidity. Abbreviations CSCcomposite scoring criteriaHPVhuman papilloma viruspN+pathology-proved viable nodal metastasispN−no persistent nodal metastasis on dissection