CT Predictors of Sub-centimeter Occult Lymph Node Metastases in Oral Cavity Squamous Cell Carcinoma: A Case-control Study

Overview

Journal Neuroradiol J

Publisher Sage Publications

Specialties Neurology
Radiology

Date 2023 Dec 26

PMID 38148295

Authors

Megan V Morisada

Arnaud F Bewley

Kenneth Broadhead

Reza Assadsangabi

Alireza Paydar

Andrew C Birkeland

Marianne Abouyared

Lihong Qi

Vladimir Ivanovic

Affiliations

Soon will be listed here.

Abstract

Background: For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance.

Objective: To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology.

Methods: Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results: 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, = .01), asymmetric number (OR = 7.20, = .005), and disrupted fatty hilum (OR = 3.31, = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%.

Conclusions: In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.

Citing Articles

Early Detection of Lymph Node Metastasis Using Primary Head and Neck Cancer Computed Tomography and Fluorescence Lifetime Imaging.

Yuan N, Hassan M, Ehrlich K, Weyers B, Biddle G, Ivanovic V Diagnostics (Basel). 2024; 14(18).

PMID: 39335776 PMC: 11430879. DOI: 10.3390/diagnostics14182097.

Insights into metastatic roadmap of head and neck cancer squamous cell carcinoma based on clinical, histopathological and molecular profiles.

Mastronikolis N, Delides A, Kyrodimos E, Piperigkou Z, Spyropoulou D, Giotakis E Mol Biol Rep. 2024; 51(1):597.

PMID: 38683372 PMC: 11058607. DOI: 10.1007/s11033-024-09476-8.

References

Freihat O, Pinter T, Kedves A, Sipos D, Cselik Z, Repa I . Diffusion-Weighted Imaging (DWI) derived from PET/MRI for lymph node assessment in patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Cancer Imaging. 2020; 20(1):56. PMC: 7414722. DOI: 10.1186/s40644-020-00334-x. View

Jesse R, BARKLEY Jr H, Lindberg R, FLETCHER G . Cancer of the oral cavity. Is elective neck dissection beneficial?. Am J Surg. 1970; 120(4):505-8. DOI: 10.1016/s0002-9610(70)80016-2. View

Hoang J, Vanka J, Ludwig B, Glastonbury C . Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR Am J Roentgenol. 2012; 200(1):W17-25. DOI: 10.2214/AJR.12.8960. View

Yii N, Patel S, Rhys-Evans P, Breach N . Management of the N0 neck in early cancer of the oral tongue. Clin Otolaryngol Allied Sci. 1999; 24(1):75-9. DOI: 10.1046/j.1365-2273.1999.00224.x. View

Moore A, Hester M, Nam M, Brill Y, McGrath P, Wright H . Distinct lymph nodal sonographic characteristics in breast cancer patients at high risk for axillary metastases correlate with the final axillary stage. Br J Radiol. 2008; 81(968):630-6. DOI: 10.1259/bjr/21933846. View

Sparano A, Weinstein G, Chalian A, Yodul M, Weber R . Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg. 2004; 131(4):472-6. DOI: 10.1016/j.otohns.2004.04.008. View

Fu J, Zhu L, Li J, Chen P, Zhang C, Shi W . Value of preoperative computed tomography in predicting the local staging of cancer of the tongue at primary surgery. Br J Oral Maxillofac Surg. 2020; 58(8):997-1002. DOI: 10.1016/j.bjoms.2020.05.014. View

Matoba M, Tsuji H, Shimode Y, Nagata H, Tonami H . Diagnostic Performance of Adaptive 4D Volume Perfusion CT for Detecting Metastatic Cervical Lymph Nodes in Head and Neck Squamous Cell Carcinoma. AJR Am J Roentgenol. 2018; 211(5):1106-1111. DOI: 10.2214/AJR.17.19241. View

Yuen A, Wei W, Wong Y, Tang K . Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck. 1997; 19(7):583-8. DOI: 10.1002/(sici)1097-0347(199710)19:7<583::aid-hed4>3.0.co;2-3. View

10.

Spiro J, SPIRO R, Shah J, Sessions R, Strong E . Critical assessment of supraomohyoid neck dissection. Am J Surg. 1988; 156(4):286-9. DOI: 10.1016/s0002-9610(88)80293-9. View

11.

Lefebvre J, Coche-Dequeant B, Buisset E, Mirabel X, Van J, Prevost B . Management of early oral cavity cancer. Experience of Centre Oscar Lambret. Eur J Cancer B Oral Oncol. 1994; 30B(3):216-20. DOI: 10.1016/0964-1955(94)90095-7. View

12.

Prativadi R, Dahiya N, Kamaya A, Bhatt S . Chapter 5 Ultrasound Characteristics of Benign vs Malignant Cervical Lymph Nodes. Semin Ultrasound CT MR. 2017; 38(5):506-515. DOI: 10.1053/j.sult.2017.05.005. View

13.

Crissman J, Liu W, Gluckman J, Cummings G . Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx. Cancer. 1984; 54(12):2995-3001. DOI: 10.1002/1097-0142(19841215)54:12<2995::aid-cncr2820541230>3.0.co;2-r. View

14.

Tam S, Amit M, Zafereo M, Bell D, Weber R . Depth of invasion as a predictor of nodal disease and survival in patients with oral tongue squamous cell carcinoma. Head Neck. 2018; 41(1):177-184. DOI: 10.1002/hed.25506. View

15.

Kaya S, Yilmaz T, Gursel B, Sarac S, Sennaroglu L . The value of elective neck dissection in treatment of cancer of the tongue. Am J Otolaryngol. 2001; 22(1):59-64. DOI: 10.1053/ajot.2001.20681. View

16.

Byers R, El-Naggar A, Lee Y, Rao B, Fornage B, Terry N . Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue?. Head Neck. 1998; 20(2):138-44. DOI: 10.1002/(sici)1097-0347(199803)20:2<138::aid-hed7>3.0.co;2-3. View

17.

Zhang H, Seikaly H, Biron V, Jeffery C . Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma. Oral Oncol. 2018; 80:89-92. DOI: 10.1016/j.oraloncology.2018.04.003. View

18.

Fakih A, Rao R, Borges A, Patel A . Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg. 1989; 158(4):309-13. DOI: 10.1016/0002-9610(89)90122-0. View

19.

Som P . Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol. 1992; 158(5):961-9. DOI: 10.2214/ajr.158.5.1566697. View

20.

KLIGERMAN J, Lima R, Soares J, Prado L, Dias F, Freitas E . Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994; 168(5):391-4. DOI: 10.1016/s0002-9610(05)80082-0. View