School of Medicine and Health Sciences Poster Presentations

Title

Can Presence of Extracapsular Extension in Malignant Cervical Lymph Nodes in Patients with Oropharyngeal Cancer be Predicted with Staging MRI?

Document Type

Poster

Status

Medical Student

Abstract Category

Basic Biomedical Sciences

Keywords

Radiology, Extracapsular Extension, Oropharyngeal Cancer, MRI

Publication Date

Spring 2018

Abstract

Introduction:

Extracapsular extension (ECE) of metastatic lymph nodes has been considered a high-risk feature for loco-regional recurrence and distant metastasis after surgical resection in patients with oropharyngeal cancer (OPC). Patients with ECE classically require a multimodal treatment approach involving surgery, chemotherapy (CT) and/or radiation therapy (RT). However, post-operative RT causes significant short- and long-term sequelae, increasing patients’ morbidity and mortality. Traditionally, ECE has been determined based on histopathological analysis. A few publications have reported that certain MRI characteristics of lymph nodes can identify presence of ECE. The focus of this project is to calculate the accuracy of these previously published parameters and novel MRI characteristics of malignant lymph nodes in patients with OPC who were treated in part with selective neck dissection immediately after staging MRI.

Method:

In this IRB approved retrospective study, 28 patients with stage III or IV OPC treated with trans-oral robotic-assisted surgery (TORS) or trans-oral laser microsurgery (TLM) and selective neck dissection (SND) at the George Washington University Hospital during the past 10 years (July 1, 2007 to July 1, 2017) were included. All those included in the study were imaged with a preoperative MRI examination and had pathology reports pertaining to neck dissection. The stored images on PACS were reviewed by an experienced Neuroradiologist and a Neuroradiology fellow for the: 1) presence of suspicious nodes (SN) 2) the size of the SN, 3) the size of the area of central necrosis within SN, and 4) contour/margin of SN. Pertinent clinical and pathologic data were extracted from an electronic medical record.

Results:

Eleven out of twenty-eight patients had pathologically proven ECE. Of the MRI features characterized, presence of necrosis > 1 cm in post-contrast MRI was the most sensitive in predicting presence of ECE (72%), but had low specificity (58%). The two Radiologists differed in their analyses in less than 5% of the MRI findings.

Conclusion:

Of the MRI findings characterized in this study, presence of central necrosis > 1cm in a SN was the most sensitive MRI marker for the presence of ECE in patients with OPC, but was not specific for ECE. Ultimately, the overall accuracy of these MR findings was modest. This study demonstrates the importance of MRI in detecting ECE but also shows the need for improved standardization and accuracy of imaging characteristics predictive of ECE.

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Can Presence of Extracapsular Extension in Malignant Cervical Lymph Nodes in Patients with Oropharyngeal Cancer be Predicted with Staging MRI?

Introduction:

Extracapsular extension (ECE) of metastatic lymph nodes has been considered a high-risk feature for loco-regional recurrence and distant metastasis after surgical resection in patients with oropharyngeal cancer (OPC). Patients with ECE classically require a multimodal treatment approach involving surgery, chemotherapy (CT) and/or radiation therapy (RT). However, post-operative RT causes significant short- and long-term sequelae, increasing patients’ morbidity and mortality. Traditionally, ECE has been determined based on histopathological analysis. A few publications have reported that certain MRI characteristics of lymph nodes can identify presence of ECE. The focus of this project is to calculate the accuracy of these previously published parameters and novel MRI characteristics of malignant lymph nodes in patients with OPC who were treated in part with selective neck dissection immediately after staging MRI.

Method:

In this IRB approved retrospective study, 28 patients with stage III or IV OPC treated with trans-oral robotic-assisted surgery (TORS) or trans-oral laser microsurgery (TLM) and selective neck dissection (SND) at the George Washington University Hospital during the past 10 years (July 1, 2007 to July 1, 2017) were included. All those included in the study were imaged with a preoperative MRI examination and had pathology reports pertaining to neck dissection. The stored images on PACS were reviewed by an experienced Neuroradiologist and a Neuroradiology fellow for the: 1) presence of suspicious nodes (SN) 2) the size of the SN, 3) the size of the area of central necrosis within SN, and 4) contour/margin of SN. Pertinent clinical and pathologic data were extracted from an electronic medical record.

Results:

Eleven out of twenty-eight patients had pathologically proven ECE. Of the MRI features characterized, presence of necrosis > 1 cm in post-contrast MRI was the most sensitive in predicting presence of ECE (72%), but had low specificity (58%). The two Radiologists differed in their analyses in less than 5% of the MRI findings.

Conclusion:

Of the MRI findings characterized in this study, presence of central necrosis > 1cm in a SN was the most sensitive MRI marker for the presence of ECE in patients with OPC, but was not specific for ECE. Ultimately, the overall accuracy of these MR findings was modest. This study demonstrates the importance of MRI in detecting ECE but also shows the need for improved standardization and accuracy of imaging characteristics predictive of ECE.