Multimodal Imaging With Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging to Detect Extracapsular Extension in Head and Neck Cancer

Abstract

Objectives/Hypothesis To assess the ability of specific positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) features to detect extracapsular extension (ECE) in head and neck squamous cell carcinoma (HNSCC) patients. Study Design Retrospective study in a tertiary certified university cancer institute. Methods We performed a review of patients with advanced HNSCC at Bern University Hospital between 2014 and 2018. Patients with pretherapeutic PET/CT and/or MRI who underwent neck dissection were included, with 212 patients fulfilling inclusion criteria. Blinded evaluation of specific PET/CT and MRI features with respect to presence of ECE was performed. Histopathological examination of neck dissection specimens was used as the gold standard to determine ECE status. Results Out of the 212 included patients, 184 had PET/CT, 186 MRI, and 158 both modalities. Overall clinical stage IV (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 2.25‐11.74), ill‐defined margins in both PET/CT and MRI (OR: 3.48, 95% CI: 1.21‐9.98 and OR: 2.14, 95% CI: 0.94‐4.89, respectively), and a maximum standardized uptake value ≥ 10 (OR: 5.44, 95% CI: 1.21‐9.98) were all significant independent predictors of ECE. When combined, these four features led to a cumulative score able to predict ECE status with an accuracy of 91.43%. Conclusions The current findings indicate specific features in PET/CT and MRI are potential predictors of ECE status and may help in pretherapeutic stratification in HNSCC. Level of Evidence 4 Laryngoscope, 131:E163–E169, 2021

Lymph Node Yield and Ratio in Selective and Modified Radical Neck Dissection in Head and Neck Cancer—Impact on Oncological Outcome

“…Features such as ECE were added in the last UICC/AJCC edition. ECE is a more variable and difficult to assess histological feature than LNR, which is therefore possibly more consistent and possibly a superior prognosticator than ECE [ 9 , 47 ]. An important question to address within the frame of prospective multicentric trials would be to assess whether an LNR > 6.5% warrants postoperative chemoradiation, independent of ECE status.…”

“…In case of en bloc resections, non-specified levels are classified as “non-defined”. The standard histopathological diagnosis at our institution has been previously reported [ 9 ].…”

“…The presence of LNMs bears a major prognostic influence, with an estimated 50% reduction in overall survival in nodal negative vs. nodal positive HPV-negative HNSCC [ 6 , 7 , 8 ]. Features such as number, size, location in the neck, and the presence of extracapsular extension (ECE) among others equally have a negative impact on survival and oncological outcome [ 9 , 10 , 11 , 12 ].…”

Diagnostic accuracy of imaging modalities in detection of histopathological extranodal extension: A systematic review and meta-analysis

“…The two studies showed a very high MRI sensitivity of 100% [96% -100%] and 96% [80% -100], respectively, and accounted for 51% of the pooled sample size in the meta-analysis. Our meta-analysis included a recent study from 2020 that found the sensitivity of MRI to be of only 75% [66% -83%], opposing the accuracy of MRI [24].…”

Diagnostic accuracy of MRI and PET/CT for neck staging prior to salvage total laryngectomy

“…The following variables were retrieved and double-checked in a non-blinded manner by two authors (Galli J, Nisa L): age, initial TNM staging, initial treatment, recurrence TNM staging, details of salvage surgery performed, results of histopathologic neck node analysis from the salvage surgery, postoperative adverse events within 30 days scored according to the Clavien-Dindo classification and long-term sequelae, and status at the time of follow-up [19] . The 7th edition of the UICC classification was used for tumor staging [20] . MRI and PET/CT sequences were acquired as previously described [21,22] .…”