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

Dankbaar, Jan Willem; Pameijer, Frank A.

doi:10.20517/2394-4722.2021.112

Cited by 6 publications

(7 citation statements)

References 32 publications

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“…28,29 Improving the imaging specificity for the determination of the ENE is important for radiologists, and it may contribute to future revisions of the cancer staging. 15,30 The imaging criteria should be easily evaluated by radiologists for the prediction of the pENE. Url et al 31 accepted one criterion for predicting ENE, which was defined as infiltration of soft tissue and adjacent anatomic planes.…”

Section: Discussionmentioning

confidence: 99%

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Imaging Characteristics Predictive of Cervical Extranodal Tumor Extension in Patients With Head and Neck Squamous Cell Carcinoma

Hancioglu,

Pekcevik,

Akdogan

et al. 2023

J Comput Assist Tomogr

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Objectives The aims of the study were to determine the predictive imaging findings of extranodal extension (ENE) in metastatic cervical lymph nodes of head and neck squamous cell carcinoma and to investigate the interobserver agreement among radiologists with different experience levels. Materials and Methods Patients with cervical lymph node dissection and who had metastatic lymph nodes and preoperative imaging were included. Three radiologists evaluated nodal necrosis, irregular contour, gross invasion, and perinodal fat stranding. They also noted their overall impression regarding the presence of the ENE. Sensitivity, specificity, odds ratios based on logistic regression, and interobserver agreement of ENE status were calculated. Results Of 106 lymph nodes (that met inclusion criteria), 31 had radiologically determined ENE. On pathologic examination, 22 of 31 nodes were positive for ENE. The increasing number of metastatic lymph nodes was associated with the presence of the ENE (P = 0.010). Irregular contour had the highest sensitivity (78.6%) and gross invasion had the highest specificity (96%) for the determination of the ENE. The radiologists' impression regarding the presence of the pathlogical ENE had 39.3% sensitivity and 82% specificity. Metastatic lymph nodes with a perinodal fat stranding and with the longest diameter of greater than 2 cm were found to be strong predictors of the ENE. The gross invasion demonstrated the highest κ value (0.731) among the evaluated imaging criteria. Conclusions In the assessment of ENE, the gross invasion had the highest specificity among imaging features and showed the highest interobserver agreement. Perinodal fat stranding and the longest diameter of greater than 2 cm in a metastatic lymph node were the best predictors of the ENE.

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Section: Discussionmentioning

confidence: 99%

“…There were wide variations and conflicting data in the literature 28,29 . Improving the imaging specificity for the determination of the ENE is important for radiologists, and it may contribute to future revisions of the cancer staging 15,30 …”

Section: Discussionmentioning

confidence: 99%

Imaging Characteristics Predictive of Cervical Extranodal Tumor Extension in Patients With Head and Neck Squamous Cell Carcinoma

Hancioglu,

Pekcevik,

Akdogan

et al. 2023

J Comput Assist Tomogr

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“…For each patient’s contrast enhanced CT scan, physicians scrolled through the axial, sagittal, and/or coronal planes of the images and answered nine questions ( Appendix, A1 ). Seven commonly applied radiological features 13 were evaluated by annotators: indistinct capsular contour, irregular lymph node margin, thick-walled enhancing nodal margin, perinodal fat stranding, perinodal fat plane or gross invasion, nodal necrosis, and nodal matting. Annotators marked “present” or “absent” for each of the features if any of the lymph nodes in the patient met the criteria.…”

Section: Methodsmentioning

confidence: 99%

International Multi-Specialty Expert Physician Preoperative Identification of Extranodal Extension in Oropharyngeal Cancer Patients using Computed Tomography: Prospective Blinded Human Inter-Observer Performance Evaluation

Sahin

Wahid

Taku

et al. 2023

Preprint

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Background: Extranodal extension (ENE) is an important adverse prognostic factor in oropharyngeal cancer (OPC) and is often employed in therapeutic decision making. Clinician-based determination of ENE from radiological imaging is a difficult task with high inter-observer variability. However, the role of clinical specialty on the determination of ENE has been unexplored. Methods: Pre-therapy computed tomography (CT) images for 24 human papillomavirus-positive (HPV+) OPC patients were selected for the analysis; 6 scans were randomly chosen to be duplicated, resulting in a total of 30 scans of which 21 had pathologically-confirmed ENE. 34 expert clinician annotators, comprised of 11 radiologists, 12 surgeons, and 11 radiation oncologists separately evaluated the 30 CT scans for ENE and noted the presence or absence of specific radiographic criteria and confidence in their prediction. Discriminative performance was measured using accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and Brier score for each physician. Statistical comparisons of discriminative performance were calculated using Mann Whitney U tests. Significant radiographic factors in correct discrimination of ENE status were determined through a logistic regression analysis. Interobserver agreement was measured using Fleiss kappa. Results: The median accuracy for ENE discrimination across all specialties was 0.57. There were significant differences between radiologists and surgeons for Brier score (0.33 vs. 0.26), radiation oncologists and surgeons for sensitivity (0.48 vs. 0.69), and radiation oncologists and radiologists/surgeons for specificity (0.89 vs. 0.56). There were no significant differences between specialties for accuracy or AUC. Indistinct capsular contour, nodal necrosis, and nodal matting were significant factors in regression analysis. Fleiss kappa was less than 0.6 for all the radiographic criteria, regardless of specialty. Conclusions: Detection of ENE in HPV+OPC patients on CT imaging remains a difficult task with high variability, regardless of clinician specialty. Although some differences do exist between the specialists, they are often minimal. Further research in automated analysis of ENE from radiographic images is likely needed.

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“…Modern staging of patients suspected of primary HNSCC is made by imaging which may include ultrasound, computed tomography (CT) with or without contrast enhancement, MRI, and fluorodeoxyglucose PET (FDG PET) [66][67][68]. It is now recognized that pENE can manifest in any individual lymph node or affect multiple adjacent lymph nodes.…”

Section: Staging Of Extranodal Extension By Imaging (Radiological Ext...mentioning

confidence: 99%

Extranodal extension in head and neck squamous cell carcinoma: need for accurate pretherapeutic staging to select optimum treatment and minimize toxicity

Bradley

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review In 2017, the American Joint Committee on Cancer (AJCC) introduced the inclusion of extracapsular nodal extension (ENE) into the N staging of nonviral head and neck squamous cell carcinoma (HNSCC), while retaining the traditional N classification based on the number and sizes of metastatic nodes. The extent of ENE was further defined as microscopic ENE (ENEmi) and major ENE (ENEma) based on extent of disease beyond the nodal capsule (≤ or > 2 mm). This article reviews the evidence and progress made since these changes were introduced. Recent findings The ‘gold standard’ for evaluation ENE is histopathologic examination, the current preferred primary treatment of patients with HNSCC is by radiation-based therapy ± chemotherapy or biotherapy. The current pretreatment staging is by imaging, which needs improved reliability of radiologic rENE assessment with reporting needs to consider both sensitivity and specificity (currently computed tomography images have high-specificity but low-sensitivity). Adjuvant chemotherapy is indicated for patients with ENEma to enhance disease control, whereas for patients with ENEmi, there is a need to assess the benefit of adjuvant chemotherapy. Evidence that the presence of pENE in HPV-positive oropharyngeal carcinoma is an independent prognostic factor and should be considered for inclusion in future AJCC editions has recently emerged. Summary There remains a paucity of data on the reliability of imaging in the staging of rENE, more so the for the accurate assessment of ENEmi. Optimistic early results from use of artificial intelligence/deep learning demonstrate progress and may pave the way for better capabilities in tumor staging, treatment outcome prediction, resulting in improved survival outcomes.

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

Cited by 6 publications

References 32 publications

Imaging Characteristics Predictive of Cervical Extranodal Tumor Extension in Patients With Head and Neck Squamous Cell Carcinoma

Imaging Characteristics Predictive of Cervical Extranodal Tumor Extension in Patients With Head and Neck Squamous Cell Carcinoma

International Multi-Specialty Expert Physician Preoperative Identification of Extranodal Extension in Oropharyngeal Cancer Patients using Computed Tomography: Prospective Blinded Human Inter-Observer Performance Evaluation

Extranodal extension in head and neck squamous cell carcinoma: need for accurate pretherapeutic staging to select optimum treatment and minimize toxicity

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