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Preoperative Contrast-Enhanced CT Versus 18F-FDG PET/CT Evaluation and the Prognostic Value of Extranodal Extension for Surgical Patients with Head and Neck Squamous Cell Carcinoma

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extranodal extension (ENE) is a poor prognostic indicator for patients with head and neck squamous cell carcinoma (HNSCC), but pretreatment detection assists with proper treatment planning. This study evaluated whether the ENE of HNSCC is accurately detected by computed tomography (CT) versus fluorine 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and whether it has any impact on patient prognosis.

Methods

In this study, 186 HNSCC patients were preoperatively evaluated using contrast-enhanced CT and 18F-FDG PET/CT. The histopathologic findings for the neck dissection samples served as a standard reference. McNemar’s test and logistic regression using the generalized estimating equations were used to compare the diagnostic value of CT versus 18F-FDG PET/CT, and Cox proportional hazard regression was used to assess the prognostic value of ENE.

Results

Among the 186 study patients, 113 (60.8 %) had a neck metastasis, 44 (23.7 %) had pathologic ENE, and 37 (19.9 %) had macroscopic ENE. Radiologic ENE (rENE) on CT was documented for 48 patients (25.8 %) and 52 neck sides (19.8 %). Using 4.9 as the cutoff value for nodal maximum standardized uptake, 18F-FDG PET/CT documented rENE for 44 patients (23.7 %) and 48 neck sides (18.3 %). Compared with 18F-FDG PET/CT, CT detected ENE, with a specificity of 92.1 versus 74.4 % (p < 0.001) and an accuracy of 88.6 versus 75.3 % (p < 0.001). However, rENE was not a significant predictor of recurrence or survival (p > 0.05).

Conclusion

The findings showed that ENE of HNSCC is more accurately detected by using CT than by using 18F-FDG PET/CT. The accurate pretreatment detection of ENE may help in the planning for HNSCC treatments.

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References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.

    Article  PubMed  Google Scholar 

  2. Johnson JT, Myers EN, Bedetti CD, Barnes EL, Schramm VL Jr., Thearle PB. Cervical lymph node metastases: incidence and implications of extracapsular carcinoma. Arch Otolaryngol. 1985;111:534–7.

    Article  PubMed  CAS  Google Scholar 

  3. Snyderman NL, Johnson JT, Schramm VL Jr., Myers EN, Bedetti CD, Thearle P. Extracapsular spread of carcinoma in cervical lymph nodes: impact upon survival in patients with carcinoma of the supraglottic larynx. Cancer. 1985;56:1597–9.

    Article  PubMed  CAS  Google Scholar 

  4. Puri SK, Fan CY, Hanna E. Significance of extracapsular lymph node metastases in patients with head and neck squamous cell carcinoma. Curr Opin Otolaryngol Head Neck Surg. 2003;11:119–23.

    Article  PubMed  Google Scholar 

  5. Yousem DM, Som PM, Hackney DB, Schwaibold F, Hendrix RA. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT. Radiology. 1992;182:753–9.

    Article  PubMed  CAS  Google Scholar 

  6. King AD, Tse GM, Yuen EH, et al. Comparison of CT and MR imaging for the detection of extranodal neoplastic spread in metastatic neck nodes. Eur J Radiol. 2004;52:264–70.

    Article  PubMed  Google Scholar 

  7. Steinkamp HJ, van der Hoeck E, Bock JC, Felix R. The extracapsular spread of cervical lymph node metastases: the diagnostic value of computed tomography. Rofo. 1999;170:457–62.

    Article  PubMed  CAS  Google Scholar 

  8. Steinkamp HJ, Beck A, Werk M, Felix R. Extracapsular spread of cervical lymph node metastases: diagnostic value of magnetic resonance imaging. Rofo. 2002;174:50–55.

    Article  PubMed  CAS  Google Scholar 

  9. Ishii J, Nagasawa H, Yamane M, et al. Ultrasonography and computed tomography of extracapsular invasion in cervical lymph nodes of squamous cell carcinoma in the oral cavity. J Med Ultrasonics. 2004;31:75–9.

    Article  Google Scholar 

  10. Joo YH, Yoo Ie R, Cho KJ, Park JO, Nam IC, Kim MS. Extracapsular spread in hypopharyngeal squamous cell carcinoma: diagnostic value of FDG PET/CT. Head Neck. 2013;35:1771–6.

    Article  PubMed  Google Scholar 

  11. Chun BJ, Yoo IR, Joo YH, et al. The efficacy of 18F-FDG PET/CT imaging for extracapsular spread of the laryngeal squamous cell carcinoma. Head Neck. 2015. doi:10.1002/hed.23889.

    Google Scholar 

  12. Joo YH, Yoo Ie R, Cho KJ, et al. Relationship between extracapsular spread and FDG PET/CT in oropharyngeal squamous cell carcinoma. Acta Otolaryngol. 2013;133:1073–9.

    Article  PubMed  Google Scholar 

  13. Prabhu RS, Magliocca KR, Hanasoge S, et al. Accuracy of computed tomography for predicting pathologic nodal extracapsular extension in patients with head-and-neck cancer undergoing initial surgical resection. Int J Rad Oncol Biol Phys. 2014;88:122–9.

    Article  Google Scholar 

  14. Chai RL, Rath TJ, Johnson JT, et al. Accuracy of computed tomography in the prediction of extracapsular spread of lymph node metastases in squamous cell carcinoma of the head and neck. JAMA Otolaryngol Head Neck Surg. 2013;139:1187–94.

    Article  PubMed  Google Scholar 

  15. Som PM, Brandwein-Gensler MS. Lymph nodes of the neck. In: Som PM, Curtin HD (eds) Head and Neck Imaging. 5th ed. Mosby, St. Louis, 2011, pp 2287–384.

    Chapter  Google Scholar 

  16. Souter MA, Allison RS, Clarkson JH, Cowan IA, Coates MH, Wells JE. Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma. J Laryngol Otol. 2009;123:778–82.

    Article  PubMed  CAS  Google Scholar 

  17. Alvi A, Johnson JT. Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg. 1996;114:65–70.

    Article  PubMed  CAS  Google Scholar 

  18. Carter RL, Barr LC, O’Brien CJ, Soo KC, Shaw HJ. Transcapsular spread of metastatic squamous cell carcinoma from cervical lymph nodes. Am J Surg. 1985;150:495–9.

    Article  PubMed  CAS  Google Scholar 

  19. Grandi C, Alloisio M, Moglia D, et al. Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications. Head Neck Surg. 1985;8:67–73.

    Article  PubMed  CAS  Google Scholar 

  20. Schmid DT, Stoeckli SJ, Bandhauer F, et al. Impact of positron emission tomography on the initial staging and therapy in locoregional advanced squamous cell carcinoma of the head and neck. Laryngoscope. 2003;113:888–91.

    Article  PubMed  Google Scholar 

  21. Stokkel MP, ten Broek FW, Hordijk GJ, Koole R, van Rijk PP. Preoperative evaluation of patients with primary head and neck cancer using dual-head 18-fluorodeoxyglucose positron emission tomography. Ann Surg. 2000;231:229–34.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Hickeson M, Yun M, Matthies A, et al. Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET. Eur J Nucl Med Mol Imaging. 2002;29:1639–47.

    Article  PubMed  Google Scholar 

  23. Fukui MB, Blodgett TM, Snyderman CH, et al. Combined PET-CT in the head and neck: part 2. Diagnostic uses and pitfalls of oncologic imaging. Radiographics. 2005;25:913–30.

    Article  PubMed  Google Scholar 

  24. Dunne AA, Muller HH, Eisele DW, Kessel K, Moll R, Werner JA. Meta-analysis of the prognostic significance of perinodal spread in head and neck squamous cell carcinomas (HNSCC) patients. Eur J Cancer. 2006;42:1863–8.

    Article  PubMed  CAS  Google Scholar 

  25. Alvi A, Johnson JT. Development of distant metastasis after treatment of advanced-stage head and neck cancer. Head Neck. 1997;19:500–5.

    Article  PubMed  CAS  Google Scholar 

  26. Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005;27:843–50.

    Article  PubMed  Google Scholar 

  27. Sinha P, Lewis JS Jr., Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer. 2012;118:3519–30.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by a Grant (No. 2014-0306) from the Asan Institute for Life Science and a Grant (No. HI14C23050000) from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Seoul, Republic of Korea (J.-L. Roh).

Disclosure

There are no conflicts of interest.

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Author notes

    Authors and Affiliations

    1. Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

      Jae Ryung Lee MD, Jong-Lyel Roh MD, Seung-Ho Choi MD, Soon Yuhl Nam MD & Sang Yoon Kim MD

    2. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

      Young Jun Choi MD & Jeong Hyun Lee MD

    3. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

      Jae Seung Kim MD

    4. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

      Kyung-Ja Cho MD

    5. Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea

      Sang Yoon Kim MD

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    Correspondence to Jong-Lyel Roh MD.

    Additional information

    Jae Ryung Lee and Young Jun Choi have equally contributed to this paper.

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    Supplementary Figure S1

    Receiver operating curve analysis to determine the cutoff value for the nodal maximum standardized uptake value (SUVmax) for detecting extranodal extension before administering 18F-FDG PET/CT. Supplementary material 1 (TIFF 1183 kb)

    Supplementary Table S1

    Relationship between CT Findings and Neck Histopathology Results of ENE. Supplementary material 2 (DOC 39 kb)

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    Lee, J.R., Choi, Y.J., Roh, JL. et al. Preoperative Contrast-Enhanced CT Versus 18F-FDG PET/CT Evaluation and the Prognostic Value of Extranodal Extension for Surgical Patients with Head and Neck Squamous Cell Carcinoma. Ann Surg Oncol 22 (Suppl 3), 1020–1027 (2015). https://doi.org/10.1245/s10434-015-4689-7

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    • DOI: https://doi.org/10.1245/s10434-015-4689-7

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