Lymph Node Central Necrosis on the Computed Tomography as the Predictor of the Extra Capsular Spread in Metastatic Head and Neck Squamous Cell Carcinoma

Abstract

The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.

Recurrence risk stratification and treatment strategies of patients with stage IVa‐b hypopharyngeal squamous cell carcinoma

“…From a clinical perspective, this may be due to the similarities between ENE and LNN. 27 Our data also indicate that patients with LNN mostly present with ENE as well. Another reason why ENE was not identified as a highrisk factor may be that the number of patients enrolled in our study was still relatively limited although it was large for a single institution.…”

Radiological assessment of extranodal extension in patients with head and neck squamous cell carcinoma

“…Only one study investigated the difference in the diagnostic performance of CT for different grades of ENE. As expected, the performance of CT, primarily sensitivity and PPV, increased as the grade of ENE increased [28] .…”

“…In a recent meta-analysis, the results of 16 CT studies were pooled [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] . All these studies compared a blinded CT evaluation of lymph nodes with histological evaluation after lymph node dissection in patients with HNSCC [27] .…”

Japanese Dermatological Association Guidelines: Outlines of Guidelines for Cutaneous Squamous Cell Carcinoma 2020

“…In determining the extent of resection, resection must be designed by referring to the results of MRI along with the results of other examinations 46 . Sharma et al 47 . compared postoperative pathological findings and preoperative CT findings in 30 patients who underwent surgery for lymph node metastasis and reported the usefulness of preoperative CT examination by detecting central necrosis in preoperative CT images in 19 of the 30 patients.…”

“…Such a lesion may be distinguished as crateriform SCC.neck SCC patients and reported histological metastasis to the parotid gland in 68% and metastasis to cervical lymph nodes in 45.5% 46. Sharma et al47 compared postoperative pathological findings and preoperative CT findings in 30 patients who underwent surgery for lymph node metastasis and reported the usefulness of preoperative CT examination by detecting central necrosis in preoperative CT images in 19 of the 30 patients. Concerning preoperative PET/CT examination, there have been case series studies, but no data concerning the prognoses are…”