TY - JOUR T1 - MRI-Based Assessment of the Pharyngeal Constrictor Muscle as a Predictor of Surgical Margin after Transoral Robotic Surgery in HPV-Positive Tonsillar Cancer JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. DO - 10.3174/ajnr.A6806 AU - Y.J. Kim AU - W.-J. Jeong AU - Y.J. Bae AU - H. Kim AU - B.S. Choi AU - Y.H. Jung AU - S.H. Baik AU - L. Sunwoo AU - J.H. Kim Y1 - 2020/10/15 UR - http://www.ajnr.org/content/early/2020/10/15/ajnr.A6806.abstract N2 - BACKGROUND AND PURPOSE: Transoral robotic surgery is an emerging strategy for treating human papillomavirus–positive cancers, but the role of MR imaging in predicting the surgical outcome has not been established. We aimed to identify preoperative MR imaging characteristics that predispose the outcome of transoral robotic surgery toward an insecure (positive or close) surgical margin in human papillomavirus–positive tonsillar squamous cell carcinoma.MATERIALS AND METHODS: Between December 2012 and May 2019, sixty-nine patients underwent transoral robotic surgery at our institution. Among these, 29 who were diagnosed with human papillomavirus–positive tonsillar squamous cell carcinoma, did not receive neoadjuvant treatment, underwent preoperative 3T MR imaging, and had postoperative pathologic reports and were included in this retrospective study. Two neuroradiologists evaluated the preoperative MR imaging scans to determine the tumor spread through the pharyngeal constrictor muscle using a 5-point scale: 1, normal constrictor; 2, bulging constrictor; 3, thinning constrictor; 4, obscured constrictor; and 5, tumor protrusion into the parapharyngeal fat. The risk of an insecure surgical margin (involved or <1 mm) according to the MR imaging scores was predicted using logistic regression with the Firth correction.RESULTS: The interobserver agreement for the MR imaging scores was excellent (κ = 0.955, P < .001). A score of ≥4 could predict an insecure margin with 87.5% sensitivity and 92.3% specificity (area under the curve = 0.899) and was the only significant factor associated with an insecure margin in the multivariable analysis (OR, 6.59; 95% CI, 3.11–22.28; P < .001).CONCLUSIONS: The pre-transoral robotic surgery MR imaging scoring system for the pharyngeal constrictor muscle is a promising predictor of the surgical margin in human papillomavirus–positive tonsillar squamous cell carcinoma.AUCarea under the curvecNclinical nodecTclinical tumorHPVhuman papillomaviruspNpathologic nodepTpathologic tumorROCreceiver operating characteristicSCCsquamous cell carcinomaTORStransoral robotic surgery ER -