Lymph node central necrosis on computed tomography as predictor of extracapsular spread in metastatic head and neck squamous cell carcinoma: pilot study

Zoumalan, Richard A.; Kleinberger, Andrew J.; Morris, Luc G.T.; Ranade, Arjun; Yee, Herman; DeLacure, Mark D.; Myssiorek, David

doi:10.1017/s0022215110001453

Cited by 43 publications

(26 citation statements)

References 17 publications

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“…Cervical nodal metastasis is very common and has a substantial effect on prognosis in patients with HNSCC. Zoumalan et al (13) and Randall et al (14) reported that CNN that was visible at preoperative CT was a useful indicator of extracapsular nodal spread, which was confirmed to be an important negative prognostic indicator in patients with HNSCC, with a sensitivity of 91%-95% and a negative predictive value of 88%-98% (15)(16)(17)(18)(19). These previous studies indirectly suggested that CNN may also be a negative prognostic factor in patients with HNSCC, including NPC; the results of our current study confirm this suggestion.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Lan¹,

Huang²,

Chen³

et al. 2015

Radiology

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Purpose:To evaluate the prognostic value of cervical nodal necrosis (CNN) in patients with nasopharyngeal carcinoma (NPC) with magnetic resonance (MR) imaging. Materials and Methods:This was an institutional review board-approved retrospective study of 1800 patients with newly diagnosed stage T1, 4N1, 3M0 NPC who were treated with definitive radiation therapy, with or without chemotherapy, between January 2007 and December 2009; the requirement to obtain informed consent was waived. MR images were reviewed to assess lymph node status, and patients were divided into CNN and non-CNN groups. The overall survival, disease-free survival, regional relapse-free survival (RRFS), and distant metastasis-free survival (DMFS) were calculated with the Kaplan-Meier method, and differences were compared by using the log-rank test. Results:The incidence of CNN was 44.0% (792 of 1800). After the median follow-up period of 53 months, the 5-year overall survival, disease-free survival, RRFS, and DMFS rates of the CNN and non-CNN groups were 78.8% and 91.8%, 78.2% and 91.2%, 78.6% and 91.8%, and 78.4% and 91.6%, respectively (for all rates, P , .001). The distant metastasis rate was 18.7% (148 of 792) for the CNN group versus 4.6% (46 of 1008) for the non-CNN group (P , .01). Subgroup analysis revealed similar survival outcomes between stage N1 disease with CNN and stage N2 disease without CNN, stage N2 disease with CNN, and stage N3 disease regardless of CNN. CNN, T stage, N stage, age older than 44 years, and male sex were significant independent negative prognostic factors for overall survival, disease-free survival, RRFS, and DMFS. Conclusion:CNN is an independent negative prognostic factor in patients with NPC, and it may be appropriate to investigate whether N stage should be upgraded by one level in patients with CNN.q RSNA, 2015

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Lan¹,

Huang²,

Chen³

et al. 2015

Radiology

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“…Some studies showed that rates of distant metastasis were higher in npc patients with retropharyngeal lymph node involvement. Zoumalan et al 14 and Randall et al 15 reported that cervical node necrosis visible on preoperative ct was a useful indicator of extracapsular nodal spread, which was confirmed to be an important negative prognostic indicator in patients with head-and-neck squamous cell carcinoma, with a sensitivity of 91%-95% and a negative predictive value of 88%-98% [16][17][18][19] . Those studies appear to suggest that snn might also be an unfavourable prognostic factor in patients with npc, and the results of the present study confirmed that suggestion.…”

Section: Discussionmentioning

confidence: 98%

Sentinel Node Necrosis Is a Negative Prognostic Factor in Patients with Nasopharyngeal Carcinoma: A Magnetic Resonance Imaging Study of 252 Patients

Wei

et al. 2017

Current Oncology

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PurposeWe explored the patterns of sentinel node metastasis and investigated the prognostic value of sentinel node necrosis (snn) in patients with nasopharyngeal carcinoma (npc), based on magnetic resonance imaging (mri).Methods This retrospective study enrolled 252 patients at our institution who had metastatic lymph nodes from biopsy-confirmed npc and who were treated with definitive radiation therapy, with or without chemotherapy. All participants underwent mri before treatment, and the resulting images were reviewed to evaluate lymph node status. The patients were divided into snn and non-snn groups. Overall survival (os), tumour-free survival (tfs), regional relapse-free survival (rrfs), and distant metastasis-free survival (dmfs) were calculated by the Kaplan-Meier method, and differences were compared using the log-rank test. Factors predictive of outcome were determined by univariate and multivariate analysis. ResultsOf the 252 patients, 189 (75%) had retropharyngeal lymph node metastasis, and 189 (75%) had level iia or iib lymph node necrosis. The incidence of snn was 43.4% (91 of 210 patients with lymph node metastasis or necrosis, or both). After a median follow-up of 54 months, the 5-year rates of os, tfs, rrfs, and dmfs in the snn and non-snn groups were, respectively, 79. 4% and 95.3%, 73.5% and 93.3%, 80.4% and 96.6%, and 75.5% and 95.3% (all p < 0.01). Age greater than 40 years, snn, T stage, and N stage were significant independent negative prognostic factors for os, tfs, rrfs, and dmfs.Conclusions Metastatic retropharyngeal lymph nodes and necrotic level ii nodes both seem to act as sentinels.Sentinel node necrosis is an negative prognostic factor in patients with npc. Patients with snn have a worse prognosis.

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“…One study reported a strong correlation between ECS and necrosis with 95% sensitivity and 85% specificity. 15 A recent study by Joo et al, 21 which involved PET/CT for the identification of ECS, showed that fluorodeoxyglucose uptake could elevate sensitivity and specificity for the detection of ECS above those of contrastenhanced CT or MR imaging alone. The study showed that maximum standardized uptake values were significantly correlated with ECS (standardized uptake value detection cutoff, 2.25 on receiver operating characteristic curve demonstration; sensitivity and specificity, 85% and 88%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…Zoumalan et al 15 found that lymph node necrosis was a good predictor of ECS. Classical imaging features of ECS include spiculated or irregular node borders, loss of the adjacent fat or muscle planes, and frank infiltration into structures adjacent to the lymph node.…”

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confidence: 99%

Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma

Aiken¹,

Poliashenko

Beitler³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The increasing impact of diagnosing extracapsular spread by using imaging, especially in patients with oropharyngeal squamous cell carcinoma, highlights the need to rigorously evaluate the diagnostic accuracy of imaging. Previous analysis suggested 62.5%-80.9% sensitivity and 60%-72.7% specificity. Our goals were to evaluate the accuracy of imaging in diagnosing extracapsular spread in a cohort of patients with oral cavity squamous cell carcinoma (pathologic confirmation of extracapsular spread routinely available), as a proxy for oropharyngeal squamous cell carcinoma, and to independently assess the reliability of imaging features (radiographic lymph node necrosis, irregular borders/stranding, gross invasion, and/or node size) in predicting pathologically proven extracapsular spread.

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Lymph node central necrosis on computed tomography as predictor of extracapsular spread in metastatic head and neck squamous cell carcinoma: pilot study

Cited by 43 publications

References 17 publications

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging

Sentinel Node Necrosis Is a Negative Prognostic Factor in Patients with Nasopharyngeal Carcinoma: A Magnetic Resonance Imaging Study of 252 Patients

Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma

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