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Diagnostic performance of computed tomography features in detecting oropharyngeal squamous cell carcinoma extranodal extension.

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Title: Diagnostic performance of computed tomography features in detecting oropharyngeal squamous cell carcinoma extranodal extension.
Authors: Tran, Ngoc-Anh1, Palotai, Miklos2, Hanna, Glenn J.3, Schoenfeld, Jonathan D.4, Bay, Camden P.1, Rettig, Eleni M.5, Bunch, Paul M.6, Juliano, Amy F.7, Kelly, Hillary R.7,8, Suh, Chong Hyun9, Zander, David A.10, Morales Pinzon, Alfredo2, Kann, Benjamin H.4, Huang, Raymond Y.1,11, Haddad, Robert I.3, Guttmann, Charles R. G.2, Guenette, Jeffrey P.1,11 JPGUENETTE@BWH.HARVARD.EDU
Source: European Radiology. May2023, Vol. 33 Issue 5, p3693-3703. 11p. 2 Black and White Photographs, 4 Charts.
Subjects: Squamous cell carcinoma, Computed tomography, Head & neck cancer, Multidetector computed tomography, Human papillomavirus
Abstract: Objectives: Accurate pre-treatment imaging determination of extranodal extension (ENE) could facilitate the selection of appropriate initial therapy for HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Small studies have associated 7 CT features with ENE with varied results and agreement. This article seeks to determine the replicable diagnostic performance of these CT features for ENE. Methods: Five expert academic head/neck neuroradiologists from 5 institutions evaluate a single academic cancer center cohort of 75 consecutive HPV + OPSCC patients. In a web-based virtual laboratory for imaging research and education, the experts performed training on 7 published CT features associated with ENE and then independently identified the "single most (if any) suspicious" lymph node and presence/absence of each of the features. Inter-rater agreement was assessed using percentage agreement, Gwet's AC1, and Fleiss' kappa. Sensitivity, specificity, and positive and negative predictive values were calculated for each CT feature based on histologic ENE. Results: All 5 raters identified the same node in 52 cases (69%). In 15 cases (20%), at least one rater selected a node and at least one rater did not. In 8 cases (11%), all raters selected a node, but at least one rater selected a different node. Percentage agreement and Gwet's AC1 coefficients were > 0.80 for lesion identification, matted/conglomerated nodes, and central necrosis. Fleiss' kappa was always < 0.6. CT sensitivity for histologically confirmed ENE ranged 0.18–0.94, specificity 0.41–0.88, PPV 0.26–0.36, and NPV 0.78–0.96. Conclusions: Previously described CT features appear to have poor reproducibility among expert head/neck neuroradiologists and poor predictive value for histologic ENE. Key Points: • Previously described CT imaging features appear to have poor reproducibility among expert head and neck subspecialized neuroradiologists as well as poor predictive value for histologic ENE. • Although it may still be appropriate to comment on the presence or absence of these CT features in imaging reports, the evidence indicates that caution is warranted when incorporating these features into clinical decision-making regarding the likelihood of ENE. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Diagnostic performance of computed tomography features in detecting oropharyngeal squamous cell carcinoma extranodal extension.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Radiology%22&quot;&gt;European Radiology&lt;/searchLink&gt;. May2023, Vol. 33 Issue 5, p3693-3703. 11p. 2 Black and White Photographs, 4 Charts.
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  Label: Abstract
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  Data: Objectives: Accurate pre-treatment imaging determination of extranodal extension (ENE) could facilitate the selection of appropriate initial therapy for HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Small studies have associated 7 CT features with ENE with varied results and agreement. This article seeks to determine the replicable diagnostic performance of these CT features for ENE. Methods: Five expert academic head/neck neuroradiologists from 5 institutions evaluate a single academic cancer center cohort of 75 consecutive HPV + OPSCC patients. In a web-based virtual laboratory for imaging research and education, the experts performed training on 7 published CT features associated with ENE and then independently identified the &quot;single most (if any) suspicious&quot; lymph node and presence/absence of each of the features. Inter-rater agreement was assessed using percentage agreement, Gwet&#39;s AC1, and Fleiss&#39; kappa. Sensitivity, specificity, and positive and negative predictive values were calculated for each CT feature based on histologic ENE. Results: All 5 raters identified the same node in 52 cases (69%). In 15 cases (20%), at least one rater selected a node and at least one rater did not. In 8 cases (11%), all raters selected a node, but at least one rater selected a different node. Percentage agreement and Gwet&#39;s AC1 coefficients were &gt; 0.80 for lesion identification, matted/conglomerated nodes, and central necrosis. Fleiss&#39; kappa was always &lt; 0.6. CT sensitivity for histologically confirmed ENE ranged 0.18–0.94, specificity 0.41–0.88, PPV 0.26–0.36, and NPV 0.78–0.96. Conclusions: Previously described CT features appear to have poor reproducibility among expert head/neck neuroradiologists and poor predictive value for histologic ENE. Key Points: • Previously described CT imaging features appear to have poor reproducibility among expert head and neck subspecialized neuroradiologists as well as poor predictive value for histologic ENE. • Although it may still be appropriate to comment on the presence or absence of these CT features in imaging reports, the evidence indicates that caution is warranted when incorporating these features into clinical decision-making regarding the likelihood of ENE. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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