Article Figures & Data
Figures
- Fig 1.
57-year-old woman with a history of squamous cell carcinoma of the left side of the tongue. Enhanced CT image shows a necrotic regional nodal metastasis (arrows) in the contralateral neck that was detected on reinterpretation in the cancer center, but missed on the initial read. This was pathologically proved following neck dissection.
- Fig 2.
49-year-old woman with known cancer of the right side of the tongue and a second primary cancer of the nasopharynx detected at the time of image reinterpretation.
A, Nonenhanced axial CT image shows asymmetry of the nasopharynx, with increased tissue on the left (arrow) and obliteration of the fat along the deep musculature (levator and tensor veli palatini muscles).
B, Nonenhanced coronal CT image again shows increased tissue at the left nasopharynx (arrows). Subsequent biopsy revealed carcinoma.
- Fig 3.
80-year-old woman with primary pharyngeal cancer. A normal-sized, fat-replaced left jugulogastric lymph node was interpreted as abnormal because of inhomogeneous signal intensity.
A, Axial nonenhanced T1-weighted (600/17/1 [repetition time/echo time/excitations]) MR image shows intrinsic high signal intensity in the lymph node (arrows) consistent with fat.
B, Axial fat-suppressed T2-weighted (4000/80/1) MR image obtained at the same level as that in A shows hypointensity in the hilum of this node (arrow) consistent with suppressed fat.
Tables
Type of Change No. of Cases Nodal Missed pathologic nodes 18 Cervical 14 Retropharyngeal 4 Nodes misinterpreted as pathologic 3 Submandibular gland mistaken for nodes 2 Changes related to tumor extension Missed submucosal extension 5 Parapharyngeal 3 Preepiglottic 2 Presence or absence of cartilage invasion 5 Presence or absence of perineural spread 4 Underestimation of size or extent of tumor 4 Overestimation of size or extent of tumor 3 Changes related to primary neoplasm Primary cancer missed on imaging 8 Oral cavity 6 Pharynx 2 Normal anatomy mistaken for primary neoplasm 3 Missed second primary neoplasm 6 Missed metastasis 2 Missed middle cerebral artery aneurysm 1 - TABLE 2:
Change in tumor staging and means of verification of the change in image interpretation
Patient No. Change in TNM Verification of Change in Interpretation Patient No. Change in TNM Verification of Change in Interpretation 1 T ↑, N ↑ Pathologic 24 T ↑ Pathologic 2 T ↑ Pathologic 25 N ↑ Pathologic 3 T ↓, N ↓ Pathologic 26 T ↑, N ↑ Pathologic 4 T ↑ Pathologic 27 N ↑ Pathologic 5 T ↑ Pathologic 28 T ↑ Pathologic 6 N ↑ Pathologic 29 T ↑ Pathologic 7 N ↑ Pathologic 30 N ↑ Pathologic 8 T ↓ Pathologic 31 N ↑ Pathologic 9 T ↑, N ↑ Pathologic 32 T ↑ Pathologic 10 T ↑ Pathologic 33 N ↑ Pathologic 11 T ↑ Pathologic 34 N ↑ Radiologic 12 M ↑ Pathologic 35 T ↑ Radiologic 13 N ↓ Pathologic 36 T ↑, N ↑ Radiologic 14 T ↓ Pathologic 37 N ↓ Radiologic 15 T ↑ Pathologic 38 T ↑, N ↑ Radiologic 16 N ↑ Pathologic 39 T ↓ Radiologic 17 T ↓, N ↓ Pathologic 40 N ↑ Radiologic 18 T ↑ Pathologic 41 M ↑ Radiologic 19 N ↑ Pathologic 42 N ↑ Radiologic 20 N ↑ Pathologic 43 N ↑ Radiologic 21 T ↑ Pathologic 44 N ↓ Clinical/imaging 22 T ↑ Pathologic 45 T ↑ Clinical/imaging 23 T ↑, N ↓ Pathologic 46 T ↑, N ↑ Clinical/imaging Note.—↑ indicates upstaged; ↓, downstaged; Radiologic, characteristic radiologic findings; Clinical/imaging, clinical and imaging follow-up.
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