Positive Predictive Value of Neck Imaging Reporting and Data System Categories 3 and 4 Posttreatment FDG-PET/CT in Head and Neck Squamous Cell Carcinoma

Abstract

BACKGROUND AND PURPOSE: The Neck Imaging Reporting and Data System is a standardized reporting system intended to risk stratify patients treated for head and neck squamous cell carcinoma. The purpose of this study is to investigate the positive predictive value of the Neck Imaging Reporting and Data System categories 3 and 4 on posttreatment PET/CT in patients treated definitively for head and neck squamous cell carcinoma. MATERIALS AND METHODS:We retrospectively identified patients treated definitively for head and neck squamous cell carcinoma between 2006 and 2018. Patients whose posttreatment PET/CT scans were interpreted as Neck Imaging Reporting and Data System 3 (suspicious) or 4 (definitive recurrence) at the primary site, regional nodes, or at distant sites were included. The reference standard was histopathology or unequivocal imaging or clinical evidence of treatment failure. The positive predictive values of Neck Imaging Reporting and Data System 3 and 4 posttreatment PET/CT were calculated.RESULTS: Seventy-two of 128 patients with posttreatment PET/CT interpreted as Neck Imaging Reporting and Data System 3 at the primary site, regional nodes, or distant sites were proved to have treatment failure at the suspicious sites, yielding an overall positive predictive value of 56% (95% CI, 48%-65%). The positive predictive values of Neck Imaging Reporting and Data System 3 by subsite were as follows: primary site, 56% (44/79); regional nodes, 65% (34/52); and distant sites, 79% (42/53). All 69 patients with posttreatment PET/CT interpreted as Neck Imaging Reporting and Data System 4 had true treatment failure, yielding a positive predictive value of 100% (95% CI, 96%-100%): primary site, 100% (28/28); regional nodes, 100% (32/32); and distant sites, 100% (29/29). CONCLUSIONS:The positive predictive value of Neck Imaging Reporting and Data System 3 on posttreatment PET/CT is relatively low. Thus, Neck Imaging Reporting and Data System 3 findings should be confirmed with tissue sampling before instituting new salvage treatment regimens to avoid unnecessary overtreatment and its associated toxicities. Neck Imaging Reporting and Data System 4 reliably indicates recurrent disease. ABBREVIATIONS: AJCC ¼ American Joint Committee on Cancer; D ¼ distant sites; HNSCC ¼ head and neck squamous cell carcinoma; HPV ¼ human papillomavirus; N ¼ regional nodes; NI-RADS ¼ Neck Imaging Reporting and Data System; P ¼ primary site; PPV ¼ positive predictive value

Diagnostic Performance of Response Assessment FDG‐PET/CECT in HNSCC Treated With Definitive Radio(chemo)therapy Using NI‐RADS

“…Cox proportional hazards model demonstrated a strong association between the NI‐RADS category and treatment failure both at the primary site and the neck with a hazard ratio of 2.60 (95% CI: 1.43‐4.72; p = .0017) and 5.22 (95% CI: 2.47‐11.0; p = .000015), respectively. Another retrospective study 36 sought to investigate the PPV of NI‐RADS categories 3 (high suspicion) and 4 (definite recurrence) to assess the need for tissue sampling for confirmation of recurrent disease. Seventy‐two of 128 patients with NI‐RADS category 3 were detected to have true treatment failure at the suspicious site yielding an overall PPV of 56% (95% CI: 48‐65) which was relatively low prompting the conclusion that findings in the NI‐RADS category 3 should be confirmed with biopsy before offering aggressive salvage therapies to avoid overtreatment and associated toxicities.…”

Performance of the Neck Imaging Reporting and Data System as applied by general neuroradiologists to predict recurrence of head and neck cancers

“…NI-RADS scores at the primary site and neck were provided by 21 neuroradiologists with 1-19 years of experience (1,1,2,2,3,4,4,5,7,8,10,10,13,13,14,15,15,16,18,18,19), including two neuroradiologists who regularly participate in ENT tumor boards (4 and 5 years of experience). These scores were given prospectively, and the cases were not re-reviewed.…”

“…NI‐RADS performance was first evaluated by Krieger et al 9 in 2017, with the authors finding that the NI‐RADS categories had good discrimination in predicting recurrent disease. Further studies have added additional support for the NI‐RADS system, showing good inter‐reader and intra‐reader agreement and strong positive predictive value (PPV) for recurrence 10–13 . However, the original assessment of NI‐RADS performance by Kreiger et al 9 employed a small dedicated team of head and neck neuroradiologists, a setup used by only a small subset of clinical practices.…”

“…Further studies have added additional support for the NI-RADS system, showing good inter-reader and intra-reader agreement and strong positive predictive value (PPV) for recurrence. [10][11][12][13] However, the original assessment of NI-RADS performance by Kreiger et al 9 employed a small dedicated team of head and neck neuroradiologists, a setup used by only a small subset of clinical practices. Most radiology practices are staffed in a fashion similar to that used in our institution, where head and neck scans are commonly interpreted by general neuroradiologists who also interpret brain and spine scans.…”

PET/MR Imaging in Evaluating Treatment Failure of Head and Neck Malignancies: A Neck Imaging Reporting and Data System–Based Study

“…13 Since the inception of NI-RADS in 2017, several studies have validated its use for reporting of PET/CT studies. [15][16][17] Most of these studies have specifically applied NI-RADS to the surveillance of squamous cell carcinoma (SCC), which accounts for most head and neck cancers.…”