Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC). Study Design: Retrospective study. Methods: Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologist-specific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature. Results: Thirty-two (44%) patients had ENE-positive lymph nodes. The presence of irregular margins (ORA = 12.3, 95% confidence interval [CI]A = 2.3–65.9; ORB = 7.0, 95% CIB = 1.4–36.3) and absence of perinodal fat plane (ORA = 6.8, 95% CIA = 2.0–23.3; ORB = 14.2, 95% CIB = 1.7–120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (SnA = 45%, SpA = 94%, AUCA = 69%, PPVA = 82%, NPVA = 73%; SnB = 28%, SpB = 95%, AUCB = 61%, PPVB = 80%, NPVB = 64%). Absence of perinodal fat plane was most sensitive for ENE (SnA = 87%, SpA = 50%, AUCA = 69%, PPVA = 59%, NPVA = 62%; SnB = 96%, SpB = 34%, AUCB = 65%, PPVB = 53%, NPVB = 63%). Conclusions: Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively. Level of Evidence: 4 Laryngoscope, 2019.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Oropharyngeal Neoplasms
Fats
Tomography
Lymph Nodes
Carcinoma
Laryngoscopes
Lymph Node Excision
ROC Curve
Area Under Curve
Cysts
Necrosis
Retrospective Studies
Logistic Models
Odds Ratio
Confidence Intervals
Neoplasm Metastasis
Sensitivity and Specificity
Radiologists

Keywords

  • computed tomography
  • extranodal extension
  • HPV
  • Oropharynx
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@article{37cfe2db45fa4891a81c9d07e142ef22,
title = "Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer",
abstract = "Objectives: To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC). Study Design: Retrospective study. Methods: Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologist-specific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature. Results: Thirty-two (44{\%}) patients had ENE-positive lymph nodes. The presence of irregular margins (ORA = 12.3, 95{\%} confidence interval [CI]A = 2.3–65.9; ORB = 7.0, 95{\%} CIB = 1.4–36.3) and absence of perinodal fat plane (ORA = 6.8, 95{\%} CIA = 2.0–23.3; ORB = 14.2, 95{\%} CIB = 1.7–120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (SnA = 45{\%}, SpA = 94{\%}, AUCA = 69{\%}, PPVA = 82{\%}, NPVA = 73{\%}; SnB = 28{\%}, SpB = 95{\%}, AUCB = 61{\%}, PPVB = 80{\%}, NPVB = 64{\%}). Absence of perinodal fat plane was most sensitive for ENE (SnA = 87{\%}, SpA = 50{\%}, AUCA = 69{\%}, PPVA = 59{\%}, NPVA = 62{\%}; SnB = 96{\%}, SpB = 34{\%}, AUCB = 65{\%}, PPVB = 53{\%}, NPVB = 63{\%}). Conclusions: Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively. Level of Evidence: 4 Laryngoscope, 2019.",
keywords = "computed tomography, extranodal extension, HPV, Oropharynx, squamous cell carcinoma",
author = "Farhoud Faraji and Nafi Aygun and Stephanie Coquia and Christine Gourin and Marietta Tan and Lisa Rooper and Eisele, {David W} and Carole Fakhry",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/lary.28237",
language = "English (US)",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer

AU - Faraji, Farhoud

AU - Aygun, Nafi

AU - Coquia, Stephanie

AU - Gourin, Christine

AU - Tan, Marietta

AU - Rooper, Lisa

AU - Eisele, David W

AU - Fakhry, Carole

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC). Study Design: Retrospective study. Methods: Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologist-specific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature. Results: Thirty-two (44%) patients had ENE-positive lymph nodes. The presence of irregular margins (ORA = 12.3, 95% confidence interval [CI]A = 2.3–65.9; ORB = 7.0, 95% CIB = 1.4–36.3) and absence of perinodal fat plane (ORA = 6.8, 95% CIA = 2.0–23.3; ORB = 14.2, 95% CIB = 1.7–120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (SnA = 45%, SpA = 94%, AUCA = 69%, PPVA = 82%, NPVA = 73%; SnB = 28%, SpB = 95%, AUCB = 61%, PPVB = 80%, NPVB = 64%). Absence of perinodal fat plane was most sensitive for ENE (SnA = 87%, SpA = 50%, AUCA = 69%, PPVA = 59%, NPVA = 62%; SnB = 96%, SpB = 34%, AUCB = 65%, PPVB = 53%, NPVB = 63%). Conclusions: Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively. Level of Evidence: 4 Laryngoscope, 2019.

AB - Objectives: To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC). Study Design: Retrospective study. Methods: Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologist-specific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature. Results: Thirty-two (44%) patients had ENE-positive lymph nodes. The presence of irregular margins (ORA = 12.3, 95% confidence interval [CI]A = 2.3–65.9; ORB = 7.0, 95% CIB = 1.4–36.3) and absence of perinodal fat plane (ORA = 6.8, 95% CIA = 2.0–23.3; ORB = 14.2, 95% CIB = 1.7–120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (SnA = 45%, SpA = 94%, AUCA = 69%, PPVA = 82%, NPVA = 73%; SnB = 28%, SpB = 95%, AUCB = 61%, PPVB = 80%, NPVB = 64%). Absence of perinodal fat plane was most sensitive for ENE (SnA = 87%, SpA = 50%, AUCA = 69%, PPVA = 59%, NPVA = 62%; SnB = 96%, SpB = 34%, AUCB = 65%, PPVB = 53%, NPVB = 63%). Conclusions: Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively. Level of Evidence: 4 Laryngoscope, 2019.

KW - computed tomography

KW - extranodal extension

KW - HPV

KW - Oropharynx

KW - squamous cell carcinoma

UR - http://www.scopus.com/inward/record.url?scp=85071198712&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071198712&partnerID=8YFLogxK

U2 - 10.1002/lary.28237

DO - 10.1002/lary.28237

M3 - Article

C2 - 31411751

AN - SCOPUS:85071198712

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

ER -