Korean J Radiol.  2019 Aug;20(8):1266-1274. 10.3348/kjr.2018.0742.

Prognostic Value of Radiologic Extranodal Extension in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

• Lee B
• Choi YJ
• Kim SO
• Lee YS
• Hong JY
• Baek JH
• Lee JH

• KMID: 2453076
• DOI: http://doi.org/10.3348/kjr.2018.0742

Abstract

OBJECTIVE
To determine whether radiologic extranodal extension (ENE) appearing on pretreatment CT and MRI could predict the prognosis in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC).
MATERIALS AND METHODS
The study population was obtained from a historical cohort diagnosed with HPV-related OPSCC. A total of 134 OPSCC patients who had a metastatic lymph node on pretreatment CT or MRI were included, and radiologic ENE was evaluated by two experienced head and neck radiologists. Kaplan-Meier and multivariate Cox regression analyses were performed to evaluate the impact of radiologic ENE on progression-free survival (PFS). The diagnostic performance of CT and MRI for the diagnosis of ENE was also evaluated in patients who underwent neck dissection.
RESULTS
Seventy patients (52.2%) showed radiologic ENE-positive findings. Although patients showing radiologic ENE had a worse 3-year PFS (83.7% vs. 95.3%, p = 0.023), the association between radiologic ENE and PFS was not statistically significant on multivariate analysis (p = 0.141; hazard ratio, 2.68; 95% confidence interval, 0.72-9.97). CT or MRI had a sensitivity of 62%, specificity of 77.8%, and accuracy of 71.9% for predicting pathologic ENE.
CONCLUSION
Radiologic ENE on CT or MRI did not predict poor PFS in patients with HPV-related OPSCC, although there was a trend towards worse PFS. Further studies are warranted to determine whether radiologic ENE is a useful imaging biomarker to risk-stratify patients with HPV-related OPSCC.

Keyword

Human papillomavirus; Oropharyngeal squamous cell carcinoma; Extranodal extension; Prognosis

MeSH Terms

Carcinoma, Squamous Cell*
Cohort Studies
Diagnosis
Disease-Free Survival
Epithelial Cells*
Head
Humans*
Lymph Nodes
Magnetic Resonance Imaging
Multivariate Analysis
Neck
Neck Dissection
Prognosis
Sensitivity and Specificity

Figure

• 

  Fig. 1 Flow diagram of patient findings.ENE = extranodal extension, HPV = human papillomavirus, OPSCC = oropharyngeal squamous cell carcinoma

• 

  Fig. 2 Representative cases of radiologic ENE in patients with HPV-related OPSCC.Metastatic lymph node with infiltration of adjacent fat or other soft tissue on CT (arrow head) (A) and MRI (arrow) (B). C, D. Metastasis in lymph node with enhancement, thickening, and irregularity of nodal rim on CT and MRI (empty arrows).

• 

  Fig. 3 Kaplan-Meier curve and p values from log-rank test for PFS according to radiologic ENE.PFS was significantly worse in patients with radiologic ENE than those without, with 3-year PFS of 95.3% versus 83.7%, respectively (log-rank p = 0.023). PFS = progression-free survival

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