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Accuracy of computed tomography to predict extracapsular spread in p16‐positive squamous cell carcinoma
Author(s) -
Maxwell Jessica H.,
Rath Tanya J.,
Byrd James K.,
Albergotti William G.,
Wang Hong,
Duvvuri Umamaheswar,
Kim Seungwon,
Johnson Jonas T.,
Branstetter Barton F.,
Ferris Robert L.
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25140
Subject(s) - computed tomography , basal cell , tomography , medicine , radiology , pathology
Objective To determine the accuracy of pretreatment, contrast‐enhanced computed tomography (CT) in the diagnosis of extracapsular spread (ECS) in cervical lymph node metastases from p16‐positive head‐and‐neck squamous cell carcinoma (HNSCC). Study Design Retrospective observational study. Methods Sixty‐five (n = 65) patients diagnosed between 2004 and 2013 with p16‐positive HNSCC and with cervical lymph node metastases measuring at least 1 centimeter in diameter on pathological assessment were included. All patients underwent primary surgical treatment. Subjects' preoperative contrast‐enhanced neck CT scans were independently assigned a score for the likelihood of ECS (5‐point scale) by two board‐certified neuroradiologists. Receiver‐operating characteristic curves were generated, and optimal sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each radiologist. Results On histological analysis, the majority of patients (58%; 38/65) were found to have ECS, and 29% (19/65) of patients had ≥ three metastatic lymph nodes. For radiologist 1, PPV and NPV for ECS detection were 72% (95% confidence interval (CI), 53%–87%) and 53% (95% CI, 36%–70%), respectively. For radiologist 2, PPV and NPV for ECS detection were 82% (95% CI, 60 %–95%) and 53% (95% CI, 38%–69%), respectively. Conclusion CT is not a reliable method for determining the presence of ECS in p16‐positive HNSCC patients. Level of Evidence 4. Laryngoscope , 125:1613–1618, 2015