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

Farhoud Faraji; Nafi Aygun; Stephanie F Coquia; Christine G Gourin; Marietta Tan; Lisa M Rooper; David W Eisele; Carole Fakhry

doi:10.1002/lary.28237

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

Laryngoscope. 2020 Jun;130(6):1479-1486. doi: 10.1002/lary.28237. Epub 2019 Aug 14.

Authors

Farhoud Faraji¹, Nafi Aygun², Stephanie F Coquia², Christine G Gourin³, Marietta Tan³, Lisa M Rooper⁴, David W Eisele³, Carole Fakhry^{3

5

6}

Affiliations

¹ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, U.S.A.
² The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.
³ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
⁴ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
⁵ Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, Maryland, U.S.A.
⁶ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.

PMID: 31411751
DOI: 10.1002/lary.28237

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 (OR_A = 12.3, 95% confidence interval [CI]_A = 2.3-65.9; OR_B = 7.0, 95% CI_B = 1.4-36.3) and absence of perinodal fat plane (OR_A = 6.8, 95% CI_A = 2.0-23.3; OR_B = 14.2, 95% CI_B = 1.7-120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (Sn_A = 45%, Sp_A = 94%, AUC_A = 69%, PPV_A = 82%, NPV_A = 73%; Sn_B = 28%, Sp_B = 95%, AUC_B = 61%, PPV_B = 80%, NPV_B = 64%). Absence of perinodal fat plane was most sensitive for ENE (Sn_A = 87%, Sp_A = 50%, AUC_A = 69%, PPV_A = 59%, NPV_A = 62%; Sn_B = 96%, Sp_B = 34%, AUC_B = 65%, PPV_B = 53%, NPV_B = 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, 130:1479-1486, 2020.

Keywords: HPV; Oropharynx; computed tomography; extranodal extension; squamous cell carcinoma.

MeSH terms

Extranodal Extension*
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Oropharyngeal Neoplasms / diagnostic imaging*
Oropharyngeal Neoplasms / pathology*
Oropharyngeal Neoplasms / virology
Papillomavirus Infections / complications
Papillomavirus Infections / pathology*
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed*