Nodal assessment and extranodal extension in head and neck squamous cell cancer: insights from computed tomography and magnetic resonance imaging

Nicola Maggialetti; Ilaria Villanova; Sara Greco; Angela Sardaro; Maria Teresa Lagrasta; Claudia Dipalma; Fabio Maglitto; Eleonora Bicci; Nicola Maria Lucarelli; Chiara Copelli; Amato Antonio Stabile Ianora

doi:10.1007/s11547-024-01929-1

Nodal assessment and extranodal extension in head and neck squamous cell cancer: insights from computed tomography and magnetic resonance imaging

Radiol Med. 2024 Nov 24. doi: 10.1007/s11547-024-01929-1. Online ahead of print.

Affiliations

¹ Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy.
² Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy. saragrecosa@gmail.com.
³ Interdisciplinary Department of Medicine, Facial Surgery, Operative Unit of Maxillo, UniversityofBari"Aldo Moro", University-Hospital "Policlinico Consorziale Di Bari", Bari, Italy.
⁴ Department of Radiology, Head and Neck Unit, Careggi University Hospital, Florence, Italy.

PMID: 39580776
DOI: 10.1007/s11547-024-01929-1

Abstract

Purpose: The aim of the study was to evaluate the concordance between computed tomography (CT)/magnetic resonance imaging (MRI) and histological examination in the evaluation of lymph nodal involvement (N+) and extranodal extension (ENE+) in patients with squamous cell cancer of the head-neck district (HNSCC). The second end point was to evaluate which of the imaging features was more sensitive and specific in establishing N+ and ENE+, and comparing the diagnostic accuracy between CT and MRI.

Material and methods: 58 patients with HNSCC undergoing surgical treatment with lymph node dissection at the Policlinico of Bari were enrolled in this retrospective study. The criteria used for identifying radiological N+ (rN+) included six characteristics; the presence of any two or more criteria out of these six was considered rN+. For each rN+, the radiological extranodal extension (rENE+) was evaluated analyzing three characteristics; rENE was considered positive if any one criterion was present.

Results: Of 167 lymph nodes, 45/167 (27%) had rN+, out of which 20/45 (44%) were rENE+. On pathological examination, 38/45 (84%) nodes were N+ and 11/20 (55%) were ENE+. The agreement between imaging and histology in the evaluation of N was (149/167) 89% with a good concordance (k = 0.7). The agreement between imaging and histology in the evaluation of ENE was (35/45) 78% with a moderate concordance (k = 0.5). Loss of fatty hilum was found to be the most sensitive (84%) imaging finding in N+ evaluation. Capsular irregularity with fat stranding had the highest sensitivity (82%) for the determination of ENE+. Comparing CT and MRI imaging in the evaluation of N+ and ENE+, we found no statistically significant differences (p-value of 0.3 for N+ and p-value of 0.3 for ENE +).

Conclusions: Imaging has good confidence in detecting rN+ but modest in assessing rENE+. Further research could improve the imaging specificity for the determination of rENE.

Keywords: Computed tomography; Extranodal extension; Head and neck; Lymph nodes; Magnetic resonance imaging; Squamous cell cancer.