Improving imaging diagnosis of persistent nodal metastases after definitive therapy for oropharyngeal carcinoma

Specific signs for CT and best performance of combined criteria

J. D. Hamilton, S. Ahmed, V. C. Sandulache, Shiva Daram, T. J. Ow, H. D. Skinner, A. Rao, L. E. Ginsberg, A. J. Kumar, J. N. Myers

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1637-1642
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume34
Issue number8
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

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Neoplasm Metastasis
Carcinoma
Therapeutics
Dissection
Morbidity
Squamous Cell Carcinoma
Radiotherapy
Radiologists
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Improving imaging diagnosis of persistent nodal metastases after definitive therapy for oropharyngeal carcinoma : Specific signs for CT and best performance of combined criteria. / Hamilton, J. D.; Ahmed, S.; Sandulache, V. C.; Daram, Shiva; Ow, T. J.; Skinner, H. D.; Rao, A.; Ginsberg, L. E.; Kumar, A. J.; Myers, J. N.

In: American Journal of Neuroradiology, Vol. 34, No. 8, 01.08.2013, p. 1637-1642.

Research output: Contribution to journalArticle

Hamilton, J. D. ; Ahmed, S. ; Sandulache, V. C. ; Daram, Shiva ; Ow, T. J. ; Skinner, H. D. ; Rao, A. ; Ginsberg, L. E. ; Kumar, A. J. ; Myers, J. N. / Improving imaging diagnosis of persistent nodal metastases after definitive therapy for oropharyngeal carcinoma : Specific signs for CT and best performance of combined criteria. In: American Journal of Neuroradiology. 2013 ; Vol. 34, No. 8. pp. 1637-1642.
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abstract = "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.",
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