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Yuan N, Hassan MA, Ehrlich K, Weyers BW, Biddle G, Ivanovic V, Raslan OAA, Gui D, Abouyared M, Bewley AF, Birkeland AC, Farwell DG, Marcu L, Qi J. Early Detection of Lymph Node Metastasis Using Primary Head and Neck Cancer Computed Tomography and Fluorescence Lifetime Imaging. Diagnostics (Basel) 2024; 14:2097. [PMID: 39335776 PMCID: PMC11430879 DOI: 10.3390/diagnostics14182097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/18/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the potential of combining pre-operative CT and intra-operative fluorescence lifetime imaging (FLIm) to enhance LNM prediction in HNC using primary tumor signatures. Methods: CT and FLIm data were collected from 46 HNC patients. A total of 42 FLIm features and 924 CT radiomic features were extracted from the primary tumor site and fused. A support vector machine (SVM) model with a radial basis function kernel was trained to predict LNM. Hyperparameter tuning was conducted using 10-fold nested cross-validation. Prediction performance was evaluated using balanced accuracy (bACC) and the area under the ROC curve (AUC). Results: The model, leveraging combined CT and FLIm features, demonstrated improved testing accuracy (bACC: 0.71, AUC: 0.79) over the CT-only (bACC: 0.58, AUC: 0.67) and FLIm-only (bACC: 0.61, AUC: 0.72) models. Feature selection identified that a subset of 10 FLIm and 10 CT features provided optimal predictive capability. Feature contribution analysis identified high-pass and low-pass wavelet-filtered CT images as well as Laguerre coefficients from FLIm as key predictors. Conclusions: Combining CT and FLIm of the primary tumor improves the prediction of HNC LNM compared to either modality alone. Significance: This study underscores the potential of combining pre-operative radiomics with intra-operative FLIm for more accurate LNM prediction in HNC, offering promise to enhance patient outcomes.
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Affiliation(s)
- Nimu Yuan
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA; (N.Y.); (M.A.H.); (K.E.); (B.W.W.)
| | - Mohamed A. Hassan
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA; (N.Y.); (M.A.H.); (K.E.); (B.W.W.)
| | - Katjana Ehrlich
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA; (N.Y.); (M.A.H.); (K.E.); (B.W.W.)
| | - Brent W. Weyers
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA; (N.Y.); (M.A.H.); (K.E.); (B.W.W.)
| | - Garrick Biddle
- Department of Radiology—Neuroradiology, University of California, Davis, CA 95817, USA; (G.B.); (O.A.A.R.)
| | - Vladimir Ivanovic
- Department of Neurology, University of California, Davis, CA 95817, USA;
| | - Osama A. A. Raslan
- Department of Radiology—Neuroradiology, University of California, Davis, CA 95817, USA; (G.B.); (O.A.A.R.)
| | - Dorina Gui
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA 95817, USA;
| | - Marianne Abouyared
- Department of Otolaryngology—Head & Neck Surgery, University of California, Davis, CA 95817, USA; (M.A.); (A.F.B.); (A.C.B.)
| | - Arnaud F. Bewley
- Department of Otolaryngology—Head & Neck Surgery, University of California, Davis, CA 95817, USA; (M.A.); (A.F.B.); (A.C.B.)
| | - Andrew C. Birkeland
- Department of Otolaryngology—Head & Neck Surgery, University of California, Davis, CA 95817, USA; (M.A.); (A.F.B.); (A.C.B.)
| | - D. Gregory Farwell
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA; (N.Y.); (M.A.H.); (K.E.); (B.W.W.)
- Department of Neurological Surgery, University of California, Davis, CA 95817, USA
| | - Jinyi Qi
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA; (N.Y.); (M.A.H.); (K.E.); (B.W.W.)
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Chan TG, Wicks J, Sethi I, Becker J, Brandon D, Schmitt NC, Kaka A, Boyce B, Baddour HM, El-Deiry MW, Patel MR, Gross JH. Radiologic findings of occult nodal metastasis during clinically-N0 salvage total laryngectomy. Head Neck 2024. [PMID: 39092682 DOI: 10.1002/hed.27889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology. METHODS A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features. RESULTS Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI-RADS 2; the rest scored 1. CONCLUSIONS On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.
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Affiliation(s)
- Tyler G Chan
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jaime Wicks
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Ila Sethi
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Jennifer Becker
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - David Brandon
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Nicole C Schmitt
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Azeem Kaka
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Brian Boyce
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Harry Michael Baddour
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mark W El-Deiry
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jennifer H Gross
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Mastronikolis NS, Delides A, Kyrodimos E, Piperigkou Z, Spyropoulou D, Giotakis E, Tsiambas E, Karamanos NK. Insights into metastatic roadmap of head and neck cancer squamous cell carcinoma based on clinical, histopathological and molecular profiles. Mol Biol Rep 2024; 51:597. [PMID: 38683372 PMCID: PMC11058607 DOI: 10.1007/s11033-024-09476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
The incidence of head and neck cancer (HNC), constituting approximately one in ten cancer cases worldwide, affects approximately 644,000 individuals annually. Managing this complex disease involves various treatment modalities such as systemic therapy, radiation, and surgery, particularly for patients with locally advanced disease. HNC treatment necessitates a multidisciplinary approach due to alterations in patients' genomes affecting their functionality. Predominantly, squamous cell carcinomas (SCCs), the majority of HNCs, arise from the upper aerodigestive tract epithelium. The epidemiology, staging, diagnosis, and management techniques of head and neck squamous cell carcinoma (HNSCC), encompassing clinical, image-based, histopathological and molecular profiling, have been extensively reviewed. Lymph node metastasis (LNM) is a well-known predictive factor for HNSCC that initiates metastasis and significantly impacts HNSCC prognosis. Distant metastasis (DM) in HNSCC has been correlated to aberrant expression of cancer cell-derived cytokines and growth factors triggering abnormal activation of several signaling pathways that boost cancer cell aggressiveness. Recent advances in genetic profiling, understanding tumor microenvironment, oligometastatic disease, and immunotherapy have revolutionized treatment strategies and disease control. Future research may leverage genomics and proteomics to identify biomarkers aiding individualized HNSCC treatment. Understanding the molecular basis, genetic landscape, atypical signaling pathways, and tumor microenvironment have enhanced the comprehension of HNSCC molecular etiology. This critical review sheds light on regional and distant metastases in HNSCC, presenting major clinical and laboratory features, predictive biomarkers, and available therapeutic approaches.
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Affiliation(s)
- Nicholas S Mastronikolis
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, University of Patras, Patras, 26504, Greece.
| | - Alexander Delides
- 2nd Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, 'Attikon' University Hospital, Rimini 1, Athens, 12462, Greece
| | - Efthymios Kyrodimos
- 1st Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, 'Ippokrateion' General Hospital, Athens, Greece
| | - Zoi Piperigkou
- Biochemistry, Biochemical Analysis & Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Patras, 26504, Greece
| | - Despoina Spyropoulou
- Department of Radiation Oncology, Medical School, University of Patras, Patras, 26504, Greece
| | - Evangelos Giotakis
- 1st Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, 'Ippokrateion' General Hospital, Athens, Greece
| | | | - Nikos K Karamanos
- Biochemistry, Biochemical Analysis & Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Patras, 26504, Greece
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Morisada MV, Bewley AF, Broadhead K, Assadsangabi R, Paydar A, Birkeland AC, Abouyared M, Qi L, Ivanovic V. CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study. Neuroradiol J 2024; 37:214-220. [PMID: 38148295 PMCID: PMC10973826 DOI: 10.1177/19714009231224447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance. OBJECTIVE To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology. METHODS Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%. CONCLUSIONS In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.
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Affiliation(s)
- Megan V Morisada
- Department of Otolaryngology, University of California Davis, USA
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California Davis, USA
| | | | - Reza Assadsangabi
- Department of Radiology, Keck School of Medicine, University of Southern California, USA
| | - Alireza Paydar
- Department of Radiology, Cleveland Clinic Foundation, USA
| | | | | | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California Davis, USA
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Raviprasad A, Pierre K, Kang D, Turetsky J, Thakkar R, Batmunh B, Quisling R, Rees J, Lanier L, Slater RM, Sistrom CL, Sharma PG, Rajderkar DA, Mancuso AA. An assessment of radiology resident competency in identifying suppurative retropharyngeal lymphadenitis: an examination using the WIDI SIM platform. Emerg Radiol 2024; 31:187-192. [PMID: 38340256 DOI: 10.1007/s10140-024-02210-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND PURPOSE Suppurative retropharyngeal lymphadenitis is a retropharyngeal space infection almost exclusively seen in the young (4-8 years old) pediatric population. It can be misdiagnosed as a retropharyngeal abscess, leading to unnecessary invasive treatment procedures. This retrospective study aims to assess radiology residents' ability to independently identify CT imaging findings and make a definitive diagnosis of suppurative retropharyngeal lymphadenitis in a simulated call environment. MATERIALS AND METHODS The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a computer-aided emergency imaging simulation proven to be a reliable method for assessing resident preparedness for independent radiology call. The simulation included 65 cases across various imaging modalities of varying complexity, including normal studies, with one case specifically targeting suppurative retropharyngeal adenitis identification. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. RESULTS A total of 543 radiology residents were tested in three separate years on the imaging findings of suppurative retropharyngeal lymphadenitis using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Suppurative retropharyngeal lymphadenitis was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 3.5% of radiology residents were able to correctly identify suppurative retropharyngeal lymphadenitis on a contrast-enhanced computed tomography (CT). CONCLUSIONS Our findings underscore a potential gap in radiology residency training related to the accurate identification of suppurative retropharyngeal lymphadenitis, highlighting the potential need for enhanced educational efforts in this area.
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Affiliation(s)
- Abheek Raviprasad
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA.
| | - Kevin Pierre
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Dahyun Kang
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jordan Turetsky
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Rajvi Thakkar
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bayar Batmunh
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Ronald Quisling
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - John Rees
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Linda Lanier
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Roberta M Slater
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Christopher L Sistrom
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Priya G Sharma
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Dhanashree A Rajderkar
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Anthony A Mancuso
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
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Tuulasvaara A, Kurdo G, Martola J, Laakso SM. Cervical lymph node diameter reflects disease progression in multiple sclerosis. Mult Scler Relat Disord 2024; 84:105496. [PMID: 38354443 DOI: 10.1016/j.msard.2024.105496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune disease against the central nervous system (CNS), where B cells activate in the deep cervical lymph nodes (CLNs) before migrating to the CNS. CLN diameter in head magnetic resonance imaging (MRI) is an unexplored possible biomarker for disease activity. METHODS We measured CLN axial diameter from head MRIs of patients with active stable relapsing-remitting MS (a-RRMS-stable, n = 26), highly active stable RRMS (ha-RRMS-stable, n = 23), RRMS patients directly after a relapse (RRMS-relapse, n = 64) and follow-up MRIs from the same patients (r-RRMS-follow-up, n = 26). MRIs of primary headache syndrome patients (n = 38) served as a control group. We evaluated the correlation between CLN diameter and clinical data. RESULTS Increases in EDSS in approximately 2 year-follow up after imaging was connected to smaller CLN diameter at imaging (correlation coefficient -0.305, p = 0.009). In a regression model, age did not show a significant effect to CLN diameter in MS patients. Enlarged CLNs of over 10 mm diameter were more common in patients with shorter disease duration (p = 0.013). The largest CLN axial diameter in RRMS-relapse group was smaller than in the control group (p = 0.005), whereas MS subgroups of the study did not differ in CLN diameter. CONCLUSIONS CLN diameter appears to reflect disease duration and disease progression in MS, in line with compartmentalization of immunological activity to the CNS in time. Decrease in CLN diameter was seen also during relapse. CLN axial diameter in MRI shows promise as a feasible biomarker for assessing MS disease activity.
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Affiliation(s)
- Anni Tuulasvaara
- Department of Neurology, Brain Center, Helsinki University Hospital, Helsinki, Finland; Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Goran Kurdo
- Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Juha Martola
- Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Sini M Laakso
- Department of Neurology, Brain Center, Helsinki University Hospital, Helsinki, Finland; Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland; Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.
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Zhang W, Liu J, Jin W, Li R, Xie X, Zhao W, Xia S, Han D. Radiomics from dual-energy CT-derived iodine maps predict lymph node metastasis in head and neck squamous cell carcinoma. LA RADIOLOGIA MEDICA 2024; 129:252-267. [PMID: 38015363 DOI: 10.1007/s11547-023-01750-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To develop and validate an iodine maps-based radiomics nomogram for preoperatively predicting cervical lymph node metastasis (LNM) in head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS A total of 278 patients who pathologically confirmed as HNSCC were retrospectively recruited from two medical centers between June 2012 and July 2022. The training set (n = 152) and internal set (n = 67) were randomly selected from medical center A, and the patients from medical center B were enrolled as the external set (n = 69). The minority group in the training set was balanced by the adaptive synthetic sampling (ADASYN) approach. Radiomics features were extracted from dual-energy CT-derived iodine maps at arterial phase (AP) and venous phase (VP), respectively. Three radiomics signatures were constructed to predict the LNM by using a random forest algorithm. The independent clinical predictors for LNM were identified by multivariate analysis and combined with radiomics signatures to establish a radiomic-clinical nomogram. The performance of radiomic-clinical nomogram was evaluated with respect to its discrimination and clinical usefulness. RESULTS The AP-VP-incorporated radiomics model exhibited a great predictive performance for LNM prediction with an area under curve (AUC) of 0.885 (95% CI, 0.836-0.933) in ADASYN-training set and confirmed in all validation sets. The nomogram that incorporated AP-VP radiomics signatures, CT-reported LN status, and histological grades yielded AUCs of 0.920 (95% CI, 0.881-0.959) in ADASYN-training set, 0.858 (95% CI, 0.771-0.944) in internal validation, and 0.849 (95% CI, 0.752-0.946) in external validation, with good calibration in all cohorts (p > 0.05). Decision curve analyses indicated the nomogram was clinically useful. In addition, the predictive performance of clinical-radiomics nomogram was also validation in combing cohorts. Stratified analysis confirmed the stability of nomogram, particularly in group negative for CT-reported LNM. CONCLUSION Clinical-radiomics nomogram based on iodine maps exhibited promising performance in predicting LNM and providing valuable information for making individualized therapy decisions.
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Affiliation(s)
- Weiyuan Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Jin Liu
- Center of PET/CT, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, 650032, China
| | - Wenfeng Jin
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Ruihong Li
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Xiaojie Xie
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Wen Zhao
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Shuang Xia
- Department of Radiology, The First Central Clinical School, Tianjin Medical University, Tianjin, 300192, China
| | - Dan Han
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.
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Huang SY, Hsu WL, Liu DW, Wu EL, Peng YS, Liao ZT, Hsu RJ. Identifying Lymph Nodes and Their Statuses from Pretreatment Computer Tomography Images of Patients with Head and Neck Cancer Using a Clinical-Data-Driven Deep Learning Algorithm. Cancers (Basel) 2023; 15:5890. [PMID: 38136434 PMCID: PMC10741600 DOI: 10.3390/cancers15245890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Head and neck cancer is highly prevalent in Taiwan. Its treatment mainly relies on clinical staging, usually diagnosed from images. A major part of the diagnosis is whether lymph nodes are involved in the tumor. We present an algorithm for analyzing clinical images that integrates a deep learning model with image processing and attempt to analyze the features it uses to classify lymph nodes. METHODS We retrospectively collected pretreatment computed tomography images and surgery pathological reports for 271 patients diagnosed with, and subsequently treated for, naïve oral cavity, oropharynx, hypopharynx, and larynx cancer between 2008 and 2018. We chose a 3D UNet model trained for semantic segmentation, which was evaluated for inference in a test dataset of 29 patients. RESULTS We annotated 2527 lymph nodes. The detection rate of all lymph nodes was 80%, and Dice score was 0.71. The model has a better detection rate at larger lymph nodes. For those identified lymph nodes, we found a trend where the shorter the short axis, the more negative the lymph nodes. This is consistent with clinical observations. CONCLUSIONS The model showed a convincible lymph node detection on clinical images. We will evaluate and further improve the model in collaboration with clinical physicians.
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Affiliation(s)
- Sheng-Yao Huang
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan; (S.-Y.H.); (D.-W.L.)
- Department of Radiation Oncology, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Wen-Lin Hsu
- Department of Radiation Oncology, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
- Cancer Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Dai-Wei Liu
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan; (S.-Y.H.); (D.-W.L.)
- Department of Radiation Oncology, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
- Cancer Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Edzer L. Wu
- DeepQ Technology Corp, New Taipei City 242062, Taiwan; (E.L.W.); (Y.-S.P.); (Z.-T.L.)
| | - Yu-Shao Peng
- DeepQ Technology Corp, New Taipei City 242062, Taiwan; (E.L.W.); (Y.-S.P.); (Z.-T.L.)
| | - Zhe-Ting Liao
- DeepQ Technology Corp, New Taipei City 242062, Taiwan; (E.L.W.); (Y.-S.P.); (Z.-T.L.)
| | - Ren-Jun Hsu
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan; (S.-Y.H.); (D.-W.L.)
- Cancer Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
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9
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Qu J, Pan B, Su T, Chen Y, Zhang T, Chen X, Zhu X, Xu Z, Wang T, Zhu J, Zhang Z, Feng F, Jin Z. T1 and T2 mapping for identifying malignant lymph nodes in head and neck squamous cell carcinoma. Cancer Imaging 2023; 23:125. [PMID: 38105217 PMCID: PMC10726506 DOI: 10.1186/s40644-023-00648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND This study seeks to assess the utility of T1 and T2 mapping in distinguishing metastatic lymph nodes from reactive lymphadenopathy in patients with head and neck squamous cell carcinoma (HNSCC), using diffusion-weighted imaging (DWI) as a comparison. METHODS Between July 2017 and November 2019, 46 HNSCC patients underwent neck MRI inclusive of T1 and T2 mapping and DWI. Quantitative measurements derived from preoperative T1 and T2 mapping and DWI of metastatic and non-metastatic lymph nodes were compared using independent samples t-test or Mann-Whitney U test. Receiver operating characteristic curves and the DeLong test were employed to determine the most effective diagnostic methodology. RESULTS We examined a total of 122 lymph nodes, 45 (36.9%) of which were metastatic proven by pathology. Mean T2 values for metastatic lymph nodes were significantly lower than those for benign lymph nodes (p < 0.001). Conversely, metastatic lymph nodes exhibited significantly higher apparent diffusion coefficient (ADC) and standard deviation of T1 values (T1SD) (p < 0.001). T2 generated a significantly higher area under the curve (AUC) of 0.890 (0.826-0.954) compared to T1SD (0.711 [0.613-0.809]) and ADC (0.660 [0.562-0.758]) (p = 0.007 and p < 0.001). Combining T2, T1SD, ADC, and lymph node size achieved an AUC of 0.929 (0.875-0.983), which did not significantly enhance diagnostic performance over using T2 alone (p = 0.089). CONCLUSIONS The application of T1 and T2 mapping is feasible in differentiating metastatic from non-metastatic lymph nodes in HNSCC and can improve diagnostic efficacy compared to DWI.
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Affiliation(s)
- Jiangming Qu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Boju Pan
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xingming Chen
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xiaoli Zhu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhentan Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Tianjiao Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jinxia Zhu
- MR Research Collaboration, Siemens Healthineers Ltd, Beijing, China
| | - Zhuhua Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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10
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Baba A, Kurokawa R, Kurokawa M, Rivera-de Choudens R, Srinivasan A. Dual-energy computed tomography for improved visualization of internal jugular chain neck lymph node metastasis and nodal necrosis in head and neck squamous cell carcinoma. Jpn J Radiol 2023; 41:1351-1358. [PMID: 37347457 PMCID: PMC10687157 DOI: 10.1007/s11604-023-01460-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To evaluate and compare the utility of 40-keV virtual monochromatic imaging (VMI) reconstructed from dual-energy computed tomography (DECT) in the assessment of neck lymph node metastasis with 70-keV VMI, which is reportedly equivalent to conventional 120-kVp single-energy computed tomography. MATERIALS AND METHODS Patients with head and neck squamous cell carcinoma who had neck lymph node metastasis in contact with the sternocleidomastoid muscle (SCM) and underwent contrast-enhanced DECT were included. In 40- and 70-keV VMI, contrast differences and contrast noise ratio (CNR) between the solid component of neck lymph node metastasis (SC) and the SCM and between SC and nodal necrosis (NN) were calculated. Two board-certified radiologists independently and qualitatively evaluated the boundary discrimination between SC and SCM and the diagnostic certainty of NN. RESULTS We evaluated 45 neck lymph node metastases. The contrast difference between SC and SCM and SC and NN were significantly higher at 40-keV VMI than at 70-keV VMI (p < 0.001). The CNR between SC and SCM was significantly higher at 40-keV VMI than at 70-keV VMI (p < 0.001). Scoring of the boundary discrimination between SC and SCM as well as the diagnostic certainty of NN at 40-keV VMI was significantly higher than that at 70-keV VMI (p < 0.001). The inter-rater agreements for these scores were higher at 40-keV VMI than at 70-keV VMI. CONCLUSION Additional employing 40-keV VMI in routine clinical practice may be useful in the diagnosis of head and neck lymph node metastases and nodal necrosis.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Roberto Rivera-de Choudens
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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11
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Al-Ibraheem A, Abdlkadir AS, Shagera QA, Saraireh O, Al-Adhami D, Al-Rashdan R, Anwar F, Moghrabi S, Mohamad I, Muylle K, Estrada E, Paez D, Mansour A, Lopci E. The Diagnostic and Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Laryngeal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:5461. [PMID: 38001720 PMCID: PMC10670341 DOI: 10.3390/cancers15225461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/11/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
This retrospective study examines the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and neck magnetic resonance imaging (MRI) in detecting nodal metastasis for patients with laryngeal squamous cell carcinoma (LSCC) and assesses the predictive values of metabolic and structural features derived from 18F-FDG PET/CT. By involving 66 patients from 2014 to 2021, the sensitivity and specificity of both modalities were calculated. 18F-FDG PET/CT outperforms neck MRI for nodal disease detection, with 89% sensitivity, 65% specificity, and 77% accuracy for nodal metastasis (p = 0.03). On the other hand, neck MRI had 66% sensitivity, 62% specificity, and 64% accuracy. Approximately 11% of patients witnessed a change in their therapy intent when relying on 18F-FDG PET/CT nodal staging results. Analyzing the cohort for PET-derived metabolic and morphological parameters, a total of 167 lymph nodes (LN) were visualized. Parameters such as the LN maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN size were computed. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Among the 167 identified cervical LNs, 111 were histopathologically confirmed as positive. ROC analysis revealed the highest area under the curve for LN MTV (0.89; p < 0.01), followed by LN size (0.87; p < 0.01). Both MTV and LN size independently predicted LN metastasis through multivariate analysis. In addition, LN MTV can reliably predict false-positive LNs in preoperative staging, offering a promising imaging-based approach for further exploration.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (A.S.A.); (D.A.-A.); (F.A.)
- School of Medicine, University of Jordan, Amman 11942, Jordan
| | - Ahmed Saad Abdlkadir
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (A.S.A.); (D.A.-A.); (F.A.)
| | - Qaid Ahmed Shagera
- Nuclear Medicine Department, Institut Jules Bordet, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Omar Saraireh
- Department of Surgical Oncology, King Hussein Cancer Center (KHCC), Amman 11941, Jordan;
| | - Dhuha Al-Adhami
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (A.S.A.); (D.A.-A.); (F.A.)
| | - Rakan Al-Rashdan
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (A.S.A.); (D.A.-A.); (F.A.)
| | - Farah Anwar
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (A.S.A.); (D.A.-A.); (F.A.)
- Department of Nuclear Medicine, Warith International Cancer Institute, Karbala 56001, Iraq
| | - Serin Moghrabi
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (A.S.A.); (D.A.-A.); (F.A.)
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center (KHCC), Amman 11941, Jordan;
| | - Kristoff Muylle
- Department of Nuclear Medicine, AZ Delta, 8800 Roeselare, Belgium;
| | - Enrique Estrada
- Nuclear Medicine and Diagnostic Imaging Section, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), 6CM8+ Vienna, Austria; (E.E.); (D.P.)
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), 6CM8+ Vienna, Austria; (E.E.); (D.P.)
| | - Asem Mansour
- Department of Diagnostic Radiology, King Hussein Cancer Center (KHCC), Amman 11941, Jordan
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS, Humanitas Clinical and Research Hospital, Via Manzoni56, 20089 Milan, Italy;
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12
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Mahale AR, Mahale NA. Diagnostic dilemma of the supraclavicular lymph node in oncology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1596-1597. [PMID: 37941502 DOI: 10.1002/jcu.23595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Ajit R Mahale
- Kasturba Medical College Mangalore, Mangalore, India
- Manipal Academy of Higher Education Manipal, Manipal, India
| | - Nina Ajit Mahale
- Kasturba Medical College Mangalore, Mangalore, India
- Manipal Academy of Higher Education Manipal, Manipal, India
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13
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Vaughn JA. Imaging of Pediatric Cervical Lymphadenopathy. Neuroimaging Clin N Am 2023; 33:581-590. [PMID: 37741659 DOI: 10.1016/j.nic.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
There is a wide variety of disease entities in children, which can present with cervical adenopathy. The spectrum of pathology and imaging appearance differs in many cases from that seen in adults. This review aims to compare the strengths and limitations of the various imaging modalities available to image pediatric patients presenting with cervical adenopathy, provide guidance on when to image, and highlight the imaging appearance of both common and uncommon disorders affecting the cervical nodes in children to aid the radiologist in their clinical practice.
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Affiliation(s)
- Jennifer A Vaughn
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA; Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA; Radiology, Creighton University School of Medicine, Phoenix, AZ, USA; Barrows Neurological Institute, Phoenix, AZ, USA.
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14
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Maggialetti N, Greco CN, Lucarelli NM, Morelli C, Cianci V, Sasso S, Rubini D, Scardapane A, Stabile Ianora AA. Applications of new radiological scores: the Node-rads in colon cancer staging. LA RADIOLOGIA MEDICA 2023; 128:1287-1295. [PMID: 37704777 DOI: 10.1007/s11547-023-01703-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The study focuses on the evaluation of the new Node Reporting and Data System 1.0 (Node-rads) scoring accuracy in the assessment of metastatic lymph nodes (LN) in patients with colon carcinoma. MATERIAL AND METHODS From April 2021 to May 2022, retrospective chart reviews were performed on 67 preoperative CT (Computed Tomography) of patients undergoing excisional surgery for colon cancer at the Polyclinic of Bari, Italy. Primary endpoints were to assess lymph node size and configuration to express the likelihood of a metastatic site adopting the Node-rads score system, whose categories of risk are defined from 1 (very low) to 5 (very high). The nodal postsurgical histological evaluation was the gold standard. The relationship between Node-rads score, LN size, configuration criteria (texture, border and shape) and the presence of histological metastases was statistically evaluated. RESULTS All surgical specimens examined had correlation with Node-rads score. They were significantly more likely to present nodes micrometastasis those patients with (a) spherical LN shape (82.8%), (b) with lymph node necrosis (100%), (c) irregular borders (87%) and (d) the LN short axis more than 10 mm (61.9%). CONCLUSIONS Our experience highlights how the Node-rads system proposes an intuitive and effective definition of criteria to standardize the lymph node radiological reports in colon cancer disease. Further studies are needed to streamline the classification of the nodal and peripheral LN in all the oncological imaging.
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Affiliation(s)
- Nicola Maggialetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Chiara Noemi Greco
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Nicola Maria Lucarelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Chiara Morelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy.
| | - Valentina Cianci
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Sara Sasso
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Dino Rubini
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", 70124, Bari, Italy
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15
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Baba A, Kurokawa R, Kurokawa M, Rivera-de Choudens R, Srinivasan A. Performance of axial diameter on MR imaging for identification of retropharyngeal lymph node metastases in head and neck cancer: a systematic review and meta-analysis. Neuroradiology 2023; 65:1363-1369. [PMID: 37522935 DOI: 10.1007/s00234-023-03205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To summarize previous studies' data and to calculate the diagnostic performance of minimum axial diameter (MIAD) and maximum axial diameter (MAAD) on each of the cutoff values in retropharyngeal lymph node (RPLNs) metastases in head and neck cancer. METHODS MEDLINE, Scopus, and Embase databases were searched for systematic review. Meta-analysis was performed to summarize estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) and generate summary recipient operator characteristic (sROC). RESULTS The review identified 5 studies with a total of 634 patients (971 lesions) that were eligible for the meta-analysis. The estimated sensitivity, specificity, and DOR at MIAD 5 mm cutoff and MIAD 6 mm cutoff were 89.8% and 74.3%, 82.7% and 92.7%, and 39.1 and 57.9, respectively. The estimated sensitivity, specificity, and DOR at MAAD 7 mm cutoff and MAAD 8 mm cutoff were 90.3% and 84.7%, 62.7% and 79.9%, and 17.8 and 21.7, respectively. The AUCs of sROC at MIAD 5 mm cutoff and MIAD 6 mm cutoff were 0.922 and 0.943. At MAAD 7 mm and MAAD 8 mm, they were 0.840 and 0.888. CONCLUSION The diagnostic performance of the MIAD 6 mm cutoff in RPLN metastases from head and neck cancer was 2% higher than the MIAD 5 mm cutoff. The diagnostic performance of MIAD was higher than that of MAAD.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Roberto Rivera-de Choudens
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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16
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d’Abadie P, Michoux N, Duprez T, Schmitz S, Magremanne M, Van Eeckhout P, Gheysens O. Comparable Accuracy of Quantitative and Visual Analyses of [ 18F]FDG PET/CT for the Detection of Lymph Node Metastases from Head and Neck Squamous Cell Carcinoma. Diagnostics (Basel) 2023; 13:2638. [PMID: 37627898 PMCID: PMC10453437 DOI: 10.3390/diagnostics13162638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In head and neck squamous cell carcinoma (HNSCC), [18F]FDG PET/CT is recommended for detecting recurrent disease and in the initial staging for evaluating distant metastases, but its use in detecting cervical lymph metastases remains unclear. The aim of this study is to evaluate and compare the diagnostic accuracy of [8F]FDG-PET/CT using visual and semi-quantitative analyses for detecting the nodal involvement in HNSCC. METHODS We analyzed consecutive patients who underwent a preoperative [18F]FDG-PET/CT and neck dissection for HNSCC at our tertiary hospital. A blinded evaluation of the [18F]FDG uptake in each neck level was performed using a semi-quantitative approach (SUVmax and SUVR) and a visual grading system (uptake superior to the internal jugular vein for grade 1 and superior to the liver for grade 2). Analyses were compared to the histological results. RESULTS In our 211 patients, analyses demonstrated similar diagnostic accuracy using a semi-quantitative approach or a visual grading system. Regarding the visual grading system, [18F]FDG-PET/CT detected nodal metastases with a specificity of 83% for lymph nodes classified as grade 1 and 98% for those classified as grade 2. The sensitivity was moderate, ranging from 60 to 63%. CONCLUSIONS [18F]FDG PET/CT has a high specificity for detecting lymph node metastases in HNSCC and therefore must be considered in the nodal clinical staging.
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Affiliation(s)
- Philippe d’Abadie
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Nicolas Michoux
- Department of Radiology, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium; (N.M.); (T.D.)
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium; (N.M.); (T.D.)
| | - Sandra Schmitz
- Department of Head and Neck Surgery, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Michèle Magremanne
- Department of Stomatology and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Pascal Van Eeckhout
- Department of Pathology, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
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17
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Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
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18
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Kavitha Y, Kumar JU. A Novel Teaching-Learning Method of Utilizing Ultrasonography as a Tool to Enhance Clinical Examination Skills of House Surgeons in Evaluating Cervical Lymph Nodes. Indian J Otolaryngol Head Neck Surg 2023; 75:802-808. [PMID: 37274968 PMCID: PMC10235371 DOI: 10.1007/s12070-023-03479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/09/2023] [Indexed: 01/30/2023] Open
Abstract
Aim A study was conducted to ascertain if ultrasonography assisted learning facilitates the House Surgeons to enhance their clinical skill of identifying enlarged cervical lymph nodes. Materials and Methods A prospective, cross-sectional analytical study was conducted in the in a Medical College for 6 months from May to October 2021. It included 50 house surgeons posted to the department of ENT on rotation and patients with one or more enlarged cervical lymph nodes. Initially an ENT teacher demonstrated clinical examination of neck for lymph nodes to the House Surgeons. Each House Surgeon examined 10 patients and their findings were matched with those of ENT specialist & Ultrasonography findings (pre TL score). Further they underwent Ultrasonography assisted learning and subsequently post TL scores were found for each House Surgeon based on their findings in 10 more patients. Paired T Test was done to ascertain statistical significance between pre TL and post TL scores. Result Fifty House Surgeons (mean age 23.3 years) and 258 patients (mean age 43.5 years) were included in the study. There was significant improvement in the post TL scores of the House Surgeons obtained after ultrasonography assisted learning in comparison with pre TL scores (p < 0.001). Conclusion Ultrasonography assisted learning enhances the clinical examination skills of assessing for enlarged cervical lymph nodes.
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Affiliation(s)
- Y Kavitha
- Department of ENT, SDM College of Medical Sciences and Hospital, 580009 Dharwad, Karnataka India
| | - Joish Upendra Kumar
- Department of Radiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka 580009, India
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19
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Patel J, Maymeskul V, Kim J. Infections of the Oral Cavity and Suprahyoid Neck. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00001-8. [PMID: 37032180 DOI: 10.1016/j.coms.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Acute infections of the oral cavity and suprahyoid neck range from simple superficial conditions that can be treated as an outpatient to complex multispatial processes that require surgical intervention and inpatient admission. This article provides an imaging overview of the range of infections in this region that may be encountered by oral and maxillofacial surgeons, emergency physicians, and primary care providers.
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Affiliation(s)
- Jeet Patel
- Department of Radiology, University of Florida College of Medicine - Jacksonville, 655 West 8th Street C90, Clinical Center 2nd Floor, Jacksonville, FL 32209, USA.
| | - Volodymyr Maymeskul
- Department of Radiology, University of Florida College of Medicine - Jacksonville, 655 West 8th Street C90, Clinical Center 2nd Floor, Jacksonville, FL 32209, USA
| | - John Kim
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive B2A205, Ann Arbor, MI 48109, USA
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20
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What's in a node? The clinical and radiologic significance of Virchow's node. Abdom Radiol (NY) 2022; 47:2244-2253. [PMID: 35316379 DOI: 10.1007/s00261-022-03487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
Abstract
In 1848, Rudolf Ludwig Karl Virchow described an association of left supraclavicular lymphadenopathy with abdominal malignancy. The left supraclavicular lymph node later became commonly referred to as Virchow's node. Charles-Emile Troisier went on to describe the physical exam finding of an enlarged left supraclavicular lymph node, later termed Troisier's sign. Subsequent studies confirmed a predilection of abdominal and pelvic malignancies to preferentially metastasize to the left supraclavicular node. Identification of a pathologically enlarged left supraclavicular node raises the suspicion for abdominopelvic malignancy, particularly in the absence of right supraclavicular lymphadenopathy, and provides a safe and easy target for biopsy. Supraclavicular lymph nodes also represent a great target for diagnosis of metastatic thoracic malignancies, although thoracic malignancies can involve either right or left supraclavicular nodes and do not show a predilection for either. This article presents a review of the history, anatomy, pathophysiology, clinical significance, radiological appearance, and biopsy of Virchow's node. Key points are illustrated with relevant cases.
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21
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Giannitto C, Esposito AA, Spriano G, De Virgilio A, Avola E, Beltramini G, Carrafiello G, Casiraghi E, Coppola A, Cristofaro V, Farina D, Gaino F, Lastella G, Lofino L, Maroldi R, Piccoli F, Pignataro L, Preda L, Russo E, Solimeno L, Vatteroni G, Vidiri A, Balzarini L, Mercante G. An approach to evaluate the quality of radiological reports in Head and Neck cancer loco-regional staging: experience of two Academic Hospitals. Radiol Med 2022; 127:407-413. [PMID: 35258775 DOI: 10.1007/s11547-022-01464-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 02/01/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate the quality of the reports of loco-regional staging computed tomography (CT) or magnetic resonance imaging (MRI) in head and neck (H&N) cancer. METHODS Consecutive reports of staging CT and MRI of all H&N cancer cases from 2018 to 2020 were collected. We created lists of quality indicators for tumor (T) for each district and for node (N). We marked these as 0 or 1 in the report calculating a report score (RS) and a maximum sum (MS) of each list. Two radiologists and two otolaryngologists in consensus classified reports as low quality (LQ) if the RS fell in the percentage range 0-59% of MS and as high quality (HQ) if it fell in the range 60-100%, annotating technique and district. We evaluated the distribution of reports in these categories. RESULTS Two hundred thirty-seven reports (97 CT and 140 MRI) of 95 oral cavity, 52 laryngeal, 47 oropharyngeal, 19 hypo-pharyngeal, 14 parotid, and 10 nasopharyngeal cancers were included. Sixty-six percent of all the reports were LQ for T, 66% out of all the MRI reports, and 65% out of all CT reports were LQ. Eight-five percent of reports were HQ for N, 85% out of all the MRI reports, and 82% out of all CT reports were HQ. Reports of oral cavity, oro-nasopharynx, and parotid were LQ, respectively, in 76%, 73%, 100% and 92 out of cases. CONCLUSION Reports of staging CT/MRI in H&N cancer were LQ for T description and HQ for N description.
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Affiliation(s)
- Caterina Giannitto
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Italy.
| | - Andrea Alessandro Esposito
- Radiology Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, 20089, Rozzano, Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, 20089, Rozzano, Milan, Italy
| | - Emanuele Avola
- Postgraduate School of Radiodiagnostic, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giada Beltramini
- Maxillo-Facial Surgery and Odontostomatology Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Elena Casiraghi
- Computer Science Department, Università Degli Studi Di Milano, via Celoria 18, 20133, Milan, Italy
| | - Alessandra Coppola
- Postgraduate School of Radiodiagnostic, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Valentina Cristofaro
- Postgraduate School of Radiodiagnostic, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Francesca Gaino
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Giulia Lastella
- Postgraduate School of Radiodiagnostic, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Ludovica Lofino
- Training School in Radiology, Humanitas University, Pieve Emanuele, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Francesca Piccoli
- Training School in Radiology, Humanitas University, Pieve Emanuele, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Lorenzo Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Radiology Department, San Matteo Hospital, Pavia, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, 20089, Rozzano, Milan, Italy
| | - Lorenzo Solimeno
- Postgraduate School of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Vatteroni
- Training School in Radiology, Humanitas University, Pieve Emanuele, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Luca Balzarini
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, 20089, Rozzano, Milan, Italy
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22
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Penha D, Pinto E, Monaghan C, Hochhegger B, Marchiori E, Taborda-Barata L, Irion K, Ravara S, Kauczor HU. Incidental findings on lung cancer screening: pictorial essay and systematic checklist. J Bras Pneumol 2022; 48:e20210371. [PMID: 35137873 PMCID: PMC8836644 DOI: 10.36416/1806-3756/e20210371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Lung cancer screening (LCS) programs are increasing worldwide. Incidental findings (IFs) on LCS are defined as low-dose CT findings unrelated to the primary purpose of identifying lung cancer. Most IFs on LCS are benign and clinically insignificant but are being increasingly recognized, and some require urgent referral for further diagnostic workup. Other findings are expected and are known as smoking-related comorbidities, including COPD, cardiovascular disease, emphysema, and interstitial lung disease, and their diagnosis can have a significant impact on patient prognosis. The purpose of this pictorial essay is to illustrate the most common IFs on LCS, organized by organ. We will discuss the current literature on IFs on LCS, focusing on their prevalence, appropriate communication, and triggering of clinical pathway systems.
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Affiliation(s)
- Diana Penha
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Erique Pinto
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Colin Monaghan
- . Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil.,. University of Florida. Department of Radiology. Gainesville (FL) USA
| | - Edson Marchiori
- . Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Luís Taborda-Barata
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior - CICS-UBI - Covilhã, Portugal
| | - Klaus Irion
- . Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Sofia Ravara
- . Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior - CICS-UBI - Covilhã, Portugal.,. Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,. Setor de Pneumologia, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Hans-Ulrich Kauczor
- . Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.,. Translational Lung Research Center, Heidelberg, Germany
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23
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Chiu K, Hoskin P, Gupta A, Butt R, Terparia S, Codd L, Tsang Y, Bhudia J, Killen H, Kane C, Ghoshray S, Lemon C, Megias D. The quantitative impact of joint peer review with a specialist radiologist in head and neck cancer radiotherapy planning. Br J Radiol 2022; 95:20211219. [PMID: 34918547 PMCID: PMC8822559 DOI: 10.1259/bjr.20211219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Radiologist input in peer review of head and neck radiotherapy has been introduced as a routine departmental approach. The aim was to evaluate this practice and to quantitatively analyse the changes made. METHODS Patients treated with radical-dose radiotherapy between August and November 2020 were reviewed. The incidence of major and minor changes, as defined by The Royal College of Radiologists guidance, was prospectively recorded. The amended radiotherapy volumes were compared with the original volumes using Jaccard Index (JI) to assess conformity; Geographical Miss Index (GMI) for undercontouring; and Hausdorff Distance (HD) between the volumes. RESULTS In total, 73 out of 87 (84%) patients were discussed. Changes were recommended in 38 (52%) patients: 30 had ≥1 major change, eight had minor changes only. There were 99 amended volumes: The overall median JI, GMI and HD was 0.91 (interquartile range [IQR]=0.80-0.97), 0.06 (IQR = 0.02-0.18) and 0.42 cm (IQR = 0.20-1.17 cm), respectively. The nodal gross-tumour-volume (GTVn) and therapeutic high-dose nodal clinical-target-volume (CTVn) had the biggest magnitude of changes: The median JI, GMI and HD of GTVn was 0.89 (IQR = 0.44-0.95), 0.11 (IQR = 0.05-0.51), 3.71 cm (IQR = 0.31-6.93 cm); high-dose CTVn was 0.78 (IQR = 0.59-0.90), 0.20 (IQR = 0.07-0.31) and 3.28 cm (IQR = 1.22-6.18 cm), respectively. There was no observed difference in the quantitative indices of the 85 'major' and 14 'minor' volumes (p = 0.5). CONCLUSIONS Routine head and neck radiologist input in radiotherapy peer review is feasible and can help avoid gross error in contouring. ADVANCES IN KNOWLEDGE The major and minor classifications may benefit from differentiation with quantitative indices but requires correlation from clinical outcomes.
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Affiliation(s)
- Kevin Chiu
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Peter Hoskin
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Amit Gupta
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Roeum Butt
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Samsara Terparia
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Louise Codd
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Yatman Tsang
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Jyotsna Bhudia
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Helen Killen
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Clare Kane
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Catherine Lemon
- Department of Head & Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Daniel Megias
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
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24
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Chin O, Alshafai L, O'Sullivan B, Su J, Hope A, Bartlett E, Hansen AR, Waldron J, Chepeha D, Xu W, Huang SH, Yu E. Inter-rater concordance and operating definitions of radiologic nodal feature assessment in human papillomavirus-positive oropharyngeal carcinoma. Oral Oncol 2022; 125:105716. [PMID: 35038657 DOI: 10.1016/j.oraloncology.2022.105716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE This study aims to evaluate the reliability of radiologic nodal feature assessment in clinical node-positive human papillomavirus-positive oropharyngeal carcinoma. MATERIALS AND METHODS Baseline CTs or MRIs of clinical node-positive human papillomavirus-positive oropharyngeal carcinoma diagnosed between 2012 and 2015 were reviewed independently by two neuroradiologists for seven nodal features: radiologic nodal involvement, cystic change, presence of necrosis, clustering, conglomeration, coalescence, and extranodal extension. Consensus operating definitions were derived after discussion. The features were re-reviewed in a randomly selected cohort. Levels of certainty (probability of presence: <25%, ∼50%, ∼75%, and >90%) were recorded. Interrater concordance was calculated using Cohen's kappa coefficient. RESULTS A total of 413 patients (826 necks) were eligible. At initial review, the inter-rater kappa values for: radiologic nodal involvement, cystic change, necrosis, clustering, conglomeration, coalescence, and extranodal extension were 0.92, 0.64, 0.48, 0.32, 0.32, 0.62, and 0.56, respectively. A re-review of 94 randomly selected cases (188 necks) after consolidation of operating definitions for nodal features showed that the inter-rater kappa values of these features were 0.83, 0.62, 0.58, 0.32, 0.18, 0.68, and 0.74 when considering ≥50% certainty as positive, and improved to 0.94, 0.66, 0.59, 0.33, 0.19, 0.76, and 0.86 when considering ≥75% certainty as positive. CONCLUSION Clearly defined nomenclature results in improved interrater reliability when assessing radiologic nodal features, especially for coalescent adenopathy and extranodal extension. Higher levels of certainty are associated with higher inter-rater agreement. Radiology reporting should include clear definitions of clinically relevant nodal features as well as levels of certainty to serve various needs in clinical care and research.
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Affiliation(s)
- Olivia Chin
- Department of Neuroradiology, University of Toronto, Toronto, Canada
| | - Laila Alshafai
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jie Su
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Eric Bartlett
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Aaron R Hansen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Douglas Chepeha
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Eugene Yu
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
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25
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Mahajan A, Agarwal U, Gupta A, Shukla S, Ashtekar R, Shah P, Sable N, Ankathi S, Ahuja A, Noronha V, Prabhash K, Menon N, Patil V, Vaish R, D' CRUZ A. Synoptic reporting in head and neck cancers— Head and Neck Cancer Imaging Reporting and Data Systems (HN-CIRADS): The journey ahead for standardization of imaging in head and neck cancer staging. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_304_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Elsholtz FHJ, Ro SR, Shnayien S, Dinkelborg P, Hamm B, Schaafs LA. Impact of double reading on NI-RADS diagnostic accuracy in reporting oral squamous cell carcinoma surveillance imaging - a single-center study. Dentomaxillofac Radiol 2022; 51:20210168. [PMID: 34233509 PMCID: PMC8693328 DOI: 10.1259/dmfr.20210168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The Neck Imaging Reporting and Data System (NI-RADS) is an increasingly utilized risk stratification tool for imaging surveillance after treatment for head and neck cancer. This study aims to measure the impact of supervision by subspecialized radiologists on diagnostic accuracy of NI-RADS when initial reading is performed by residents. METHODS 150 CT and MRI datasets were initially read by two trained residents, and then supervised by two subspecialized radiologists. Recurrence rates by NI-RADS category were calculated, and receiver operating characteristic (ROC) curves were plotted. After dichotomization of the NI-RADS system (category 1 vs categories 2 + 3+4 and categories 1 + 2 vs 3 + 4), sensitivity, specificity, positive and negative predictive value were calculated. RESULTS 26% of the reports were modified by the supervising radiologists. Area under the curve of ROC plots values of the supervision session were higher than those of the initial reading session for both the primary site (0.89 vs 0.86) and the neck (0.94 vs 0.91), but the difference was not statistically significant. For dichotomized NI-RADS category assignments, differences between the initial reading and the supervision session were statistically significant regarding specificity and PPV for the primary site (1 + 2 vs 3 + 4 and 1 vs 2 + 3+4) or even for both sites combined (1 vs 2 + 3+4). CONCLUSION NI-RADS enables trained resident radiologists to report surveillance imaging in patients with treated oral squamous cell carcinoma with high discriminatory power. Additional supervision by a subspecialized head and neck radiologist particularly improves specificity of radiological reports.
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Affiliation(s)
- Fabian Henry Jürgen Elsholtz
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Sa-Ra Ro
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Patrick Dinkelborg
- Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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27
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Lapeyre M, Racadot S, Renard S, Biau J, Moreira JF, Biston MC, Pointreau Y, Thariat J, Graff-Cailleaud P. Radiotherapy for oral cavity cancers. Cancer Radiother 2021; 26:189-198. [PMID: 34953711 DOI: 10.1016/j.canrad.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intensity modulated radiation therapy and brachytherapy are standard techniques of irradiation for the treatment of oral cavity cancers. These techniques are detailed in terms of indication, planning, delineation and selection of the volumes of interest, dosimetry and patients positioning control. This is an update of the guidelines of the French Society of Radiotherapy Correspondence.
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Affiliation(s)
- M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France.
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - S Renard
- Département de radiothérapie, Institut de cancérologie de Lorraine, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - J F Moreira
- Service de physique médicale, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - M C Biston
- Service de physique médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Y Pointreau
- Radiothérapie, Institut interrégional de cancérologie (ILC), centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - P Graff-Cailleaud
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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28
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Zou Y, Sun S, Liu Q, Liu J, Shi Y, Sun F, Gong Y, Lu X, Zhang X, Xia S. A new prediction model for lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma: Based on dual-energy CT. Eur J Radiol 2021; 145:110060. [PMID: 34839216 DOI: 10.1016/j.ejrad.2021.110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/26/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The current study aimed to develop and validate a prediction model to estimate the independent risk factors for lateral cervical lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC) patients based on dual-energy computed tomography (DECT). METHOD This study retrospectively conducted 406 consecutive patients from July 2015 to June 2019 to form the derivation cohorts and performed internal validation. 101 consecutive patients from July 2019 to June 2020 were included to create the external validation cohort. Univariable and multivariable logistic regression analyses were used to evaluate independent risk factors for LLNM. A prediction model based on DECT parameters was built and presented on a nomogram. The internal and external validations were performed. RESULTS Iodine concentration (IC) in the arterial phase (OR 2.761, 95% CI 1.028-7.415, P 0.044), IC in venous phase (OR 3.820, 95% CI 1.430-10.209, P 0.008), located in the superior pole (OR 4.181, 95% CI 2.645-6.609, P 0.000), and extrathyroidal extension (OR 4.392, 95% CI 2.142-9.004, P 0.000) were independently associated with LLNM in the derivation cohort. These four predictors were incorporated into the nomogram. The model showed good discrimination in the derivation (AUC, 0.899), internal (AUC, 0.905), and external validation (AUC, 0.912) cohorts. The decision curve revealed that more advantages would be added using the nomogram to estimate LLNM, which implied that the lateral lymph node dissection was recommended. CONCLUSIONS DECT parameters could provide independent indicators of LLNM in PTC patients, and the nomogram based on them may be helpful in treatment decision-making.
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Affiliation(s)
- Ying Zou
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China; Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China; Department of Radiology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Shuangyan Sun
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China; Department of Radiology, JiLin Cancer Hospital, No.1066 JinHu Road, ChaoYang District, ChangChun 130000, China
| | - Qian Liu
- Department of Radiology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, China
| | - Jihua Liu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China; Department of Radiology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Yan Shi
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong 256603, China
| | - Fang Sun
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong 256603, China
| | - Yan Gong
- Department of Radiology, Tianjin Hospital of ITCWM Nan Kai Hospital, No.6 Changjiang Road, Nan Kai District, Tianjin 300100, China
| | - Xiudi Lu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China; Department of Radiology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Xuening Zhang
- Department of Radiology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China.
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SUV max for predicting regional control in oropharyngeal cancer. Eur Arch Otorhinolaryngol 2021; 279:3167-3177. [PMID: 34779928 DOI: 10.1007/s00405-021-07169-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/02/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the predictive value of pretherapeutic metabolic tumor imaging using 18-fluorodeoxyglucose positron emission tomography (FDG-PET) for regional response in oropharyngeal cancer patients undergoing primary (chemo)radiation. METHODS Retrospective analysis of oropharyngeal cancer patients treated with primary (chemo)radiation at the University Hospital Zurich from 2010 to 2019 with available FDG-PET. The SUVmax of the largest lymph node metastases was recorded. Regional response was assessed using posttherapeutic FDG-PET at 12 weeks and regional recurrence-free survival. RESULTS 95 patients with a mean age of 68.5 years (SD 10.3) were included. The median pretherapeutic nodal SUVmax was 8.3 (interquartile range 4.4-13.3). A pretherapeutic nodal SUVmax above 6 significantly predicted poorer regional recurrence-free survival (log-rank test, P = 0.009) in univariate analysis. However, in multivariate analysis SUVmax above 6 was not significant in predicting regional recurrence-free survival (Cox regression P = 0.189). Clinical N category showed a trend in which a more severe stage had a poorer regional survival (Cox regression P = 0.073). CONCLUSION The SUVmax of the largest lymph node metastasis seems to play a role in predicting regional response in oropharyngeal cancer patients, after stratifying for N category. More research is needed to investigate whether highly metabolically active disease is less likely to respond to chemoradiation.
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Assadsangabi R, Maralani P, Chen AF, Loevner LA, Mohan S. Common blind spots and interpretive errors of neck imaging. Clin Imaging 2021; 82:29-37. [PMID: 34773810 DOI: 10.1016/j.clinimag.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Complex anatomy and a wide spectrum of diseases in the head and neck predispose interpretation of neck imaging to cognitive pitfalls and perceptual errors. Extra attention to common blind spots in the neck and familiarity with common interpretive challenges could aid radiologists in preventing these diagnostic errors.
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Affiliation(s)
- Reza Assadsangabi
- Department of Radiology, Division of Neuroradiology, University of California-Davis, Sacramento, CA, USA.
| | - Pejman Maralani
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony F Chen
- Department of Radiology, Division of Neuroradiology, University of California-Davis, Sacramento, CA, USA
| | - Laurie A Loevner
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Shah PH, Karagianis AG, Lester MS, Paintal AS, McComb EN. Calcified lymph nodes in the setting of head and neck squamous cell carcinoma: A predictor of HPV positivity? Clin Imaging 2021; 81:136-142. [PMID: 34710803 DOI: 10.1016/j.clinimag.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Human papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma (HNSCC) and accounts for a large majority of new cases. The purpose of this study is to determine whether there is an association between nodal calcification and HPV positivity in the setting of metastatic HNSCC. METHODS Consecutive patients with HNSCC who underwent CT were retrospectively identified. Patients were then divided into two groups: those with HPV-positive HNSCC and those with HPV-negative HNSCC. Demographic, clinical, and CT data were compared between the two groups to determine factors associated with HPV-positive HNSCC. RESULTS A total of 179 patients with HNSCC were included in the final analyses, 104 (58%) of whom had HPV-positive tumors. Univariate analyses demonstrated that those with HPV-positive HNSCC were more likely to have calcified lymph nodes (p = 0.044). Analyses also confirmed previously known associations with male gender (p = 0.001), primary oropharyngeal tumors (p < 0.001), and cystic lymph nodes (<0.001). The HPV-positive HNSCC group was also less likely to have necrotic lymph nodes (p < 0.001). CONCLUSION In addition to known clinical and imaging factors associated with HPV-positive metastatic HNSCC, such as male gender, oropharyngeal primary location, and cystic lymph nodes, the presence of calcifications within cervical lymph nodes, although infrequent, provides an additional useful feature to predict HPV positivity in HNSCC. Additionally, if calcified lymph nodes are present, then a primary oropharyngeal tumor site should be considered.
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Affiliation(s)
- Parinda H Shah
- Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
| | - Achilles G Karagianis
- Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
| | - Malisa S Lester
- Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
| | - Ajit S Paintal
- Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
| | - Erin N McComb
- Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America.
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Ghai S, O'Brien C, Goldstein DP, Sawka AM. Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance. Insights Imaging 2021; 12:130. [PMID: 34529219 PMCID: PMC8446145 DOI: 10.1186/s13244-021-01072-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/07/2021] [Indexed: 01/25/2023] Open
Abstract
Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of suspicious lymph nodes and tumor location, there are limited reported data highlighting inherent ultrasound limitations and guidelines for case selection and follow-up. We report our experience including imaging limitations encountered in the ongoing AS prospective observational study for PTCs measuring < 2 cm at our institute. We define disease progression as an increase in size of > 3 mm in the largest dimension of nodule or evidence of metastatic disease or extrathyroidal extension. Accurate, consistent and reproducible measurements of PTCs are essential in risk stratifying patients for the option of AS or disease progression. Interobserver discrepancy, shadowing from coarse calcification and background parenchyma heterogeneity or thyroiditis can limit accurate PTC size assessment and therefore hinder patient eligibility evaluation or AS follow-up. Following the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) protocol of three-axes technique to measure a thyroid nodule enables reproducibility of measurements. In patients with multi-nodular goiter, accurate identification and labeling of the PTC is important to avoid mistaking with adjacent benign nodules at follow-up. Ultrasound assessment for extrathyroid extension of PTC, and relationship of PTC to trachea and the anatomic course of the recurrent laryngeal nerve are important considerations in evaluation for AS eligibility.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada. .,1PMB-283, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
| | - Ciara O'Brien
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Princess Margaret Cancer Centre, Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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Chasen NN, Wang JR, Gan Q, Ahmed S. Imaging of Cervical Lymph Nodes in Thyroid Cancer: Ultrasound and Computed Tomography. Neuroimaging Clin N Am 2021; 31:313-326. [PMID: 34243866 DOI: 10.1016/j.nic.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sonographic evaluation of cervical lymph nodes in patients with thyroid malignancy is important both for preoperative staging and for post-treatment surveillance, and contrast-enhanced computed tomography plays a complementary role. Knowledge of anatomy and surgical approaches, combined with an understanding of the various imaging features that distinguish malignant from benign lymph nodes, allows for accurate staging, thereby enabling complete surgical initial resection.
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Affiliation(s)
- Noah Nathan Chasen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA
| | - Jennifer Rui Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030-4009, USA
| | - Qiong Gan
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0085, Houston, TX 77030-4009, USA
| | - Salmaan Ahmed
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA.
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Chen L, Dohopolski M, Zhou Z, Wang K, Wang R, Sher D, Wang J. Attention Guided Lymph Node Malignancy Prediction in Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2021; 110:1171-1179. [PMID: 33561508 DOI: 10.1016/j.ijrobp.2021.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/11/2021] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Accurate lymph node (LN) malignancy classification is essential for treatment target identification in head and neck cancer (HNC) radiation therapy. Given the constraints imposed by relatively small sample sizes in real-world medical applications, to classify LN malignancy status accurately, we proposed an attention-guided classification (AGC) scheme that (1) incorporates human knowledge (ie, LN contours) into model training to guide model's "learning" direction, alleviating the critical requirement of large training samples by deep learning approaches; and (2) does not require accurate delineation of LNs in the inference stage but can highlight the discriminative region nearby the LN, which is important for malignancy determination. METHODS AND MATERIALS In the proposed AGC scheme, there is an attention-guided convolutional neural network (agCNN) module, followed by a classification convolutional neural network (cCNN) module. The input of the proposed AGC scheme is a region of interest (ROI) containing the LN and its surrounding tissues. The agCNN is designed to find the discriminative region in the ROI, which outputs an activation map whose voxel values indicate the importance of the voxels in malignancy prediction. Through multiplying the activation map with the ROI, we obtain the input for the cCNN, which finally outputs the LN malignancy probability. To demonstrate the effectiveness of the proposed scheme, we performed experimental studies using positron emission tomography and contrast-enhanced computed tomography from 129 surgical HNC patients, including 791 LNs, with pathologic ground truth of malignancy status. To evaluate the performance, 5-folder cross validation was used. RESULTS The sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curve values obtained by the proposed AGC scheme were 0.91, 0.93, 0.92, and 0.98, respectively, significantly outperforming conventional convolutional neural network and radiomics approaches at a significance level of .05 under a paired ROC comparison statistical test. CONCLUSIONS We developed an AGC scheme that can highlight the discriminative region in an image for LN malignancy prediction, outperforming a conventional radiomics method that requires accurate segmentation and a standard convolutional neural network model without involving segmentation.
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Affiliation(s)
- Liyuan Chen
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Dohopolski
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zhiguo Zhou
- School of Computer Science and Mathematics, University of Central Missouri, Warrensburg, Missouri
| | - Kai Wang
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rongfang Wang
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David Sher
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jing Wang
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Kim SY, Beer M, Tshering Vogel DW. Imaging in head and neck cancers: Update for non-radiologist. Oral Oncol 2021; 120:105434. [PMID: 34218063 DOI: 10.1016/j.oraloncology.2021.105434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Head and neck cancer (HNC) is the fifth most frequent cancer worldwide and associated with significant morbidity. Along with clinical examination and endoscopic evaluation, imaging plays an important role in pre- and posttherapeutic evaluation of patients with HNC. Cross-sectional Imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography / computed tomography (PET/CT) are routinely used in the assessment of these patients. This review provides an overview of the various cross-sectional imaging modalities used in the evaluation of HNC and will give a short summary of the latest imaging technologies regarding head and neck cancer diagnosis.
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Affiliation(s)
- Soung Yung Kim
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Dechen W Tshering Vogel
- University Institute for Diagnostic, Interventional and Paediatric Radiology, Inselspital University Hospital Bern, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
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Ishibashi N, Maebayashi T, Nishimaki H, Okada M. Computed Tomography of Lymph Node Metastasis Before and After Radiation Therapy: Correlations With Residual Tumour. In Vivo 2021; 34:2721-2725. [PMID: 32871805 DOI: 10.21873/invivo.12093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Computed tomography (CT) performed after radiation therapy (RT) is used to detect residual lymph node (LN) metastasis. Here, we investigated which LN parameters on pre- and post-RT CT images correlated with residual tumour in patients with head and neck cancer. PATIENTS AND METHODS We enrolled 23 patients who received RT. A total of 50 LNs were evaluated. Correlations between quantitative and qualitative findings and residual tumours were evaluated. RESULTS The median patient age was 61 years. Thirty-one LNs were histologically confirmed to contain residual tumour. LNs with residual tumour had significantly longer short and long axes on post-RT CT images. A new finding of obscured margins after RT were significantly associated with the presence of residual tumour by univariate and multivariate analyses. CONCLUSION Comparison of qualitative, LN parameters on pre- and post-RT CT images may improve the detection of residual tumour in patients with suspected residual or recurrent LN metastasis.
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Affiliation(s)
- Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Haruna Nishimaki
- Department of Oncologic Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
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Lee JY, Baek JH, Ha EJ, Sung JY, Shin JH, Kim JH, Lee MK, Jung SL, Lee YH, Ahn HS, Yoon JH, Choi YJ, Park JS, Lee YJ, Choi M, Na DG. 2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology. Korean J Radiol 2021; 22:840-860. [PMID: 33660459 PMCID: PMC8076832 DOI: 10.3348/kjr.2020.0578] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eun Ju Ha
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Lee
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chungang University Hospital, Chungang University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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Huang SH, Chernock R, O'Sullivan B, Fakhry C. Assessment Criteria and Clinical Implications of Extranodal Extension in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2021; 41:265-278. [PMID: 34010048 DOI: 10.1200/edbk_320939] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tumor breaching the capsule of a lymph node is termed extranodal extension (ENE). It reflects aggressiveness of a tumor, creates anatomic challenges for disease clearance, and increases the risk of distant metastasis. Extranodal extension can be assessed on a pathology specimen, by radiology studies, and by clinical examination. Presence of ENE in a pathology specimen has long been considered a high-risk feature of disease progression and would ordinarily benefit from the addition of chemotherapy to adjuvant radiotherapy. Although the eighth edition of the Union for International Cancer Control/American Joint Committee on Cancer stage classification dichotomizes pathologic ENE according to its presence or absence, emerging evidence suggests that the extent of a pathologic ENE may provide additional value for risk stratification to guide adjuvant therapy. Recent data suggest that the prognostic importance of pathologic ENE is also applicable for HPV-associated head and neck squamous cell carcinoma. In addition, compelling data demonstrate that indisputable radiologic ENE is a powerful risk stratification tool to identify patients at high risk for treatment failure, especially distant metastasis, applicable for both HPV-positive and HPV-negative head and neck squamous cell carcinoma. However, the definition and taxonomy of radiologic ENE requires standardization. The goal of this review is to clarify the contemporary understanding of the prognostic implications of ENE in head and neck squamous cell carcinoma, present the nuances of what is presently known and unknown, and elucidate how to classify ENE pathologically and radiologically with an understanding of the strengths and weaknesses of each approach. Finally, with the development of several risk stratification methods, the relative role of ENE and other prognostic schema will be explored.
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Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology and Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Brian O'Sullivan
- Department of Radiation Oncology and Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Carole Fakhry
- Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Elsholtz FHJ, Asbach P, Haas M, Becker M, Beets-Tan RGH, Thoeny HC, Padhani AR, Hamm B. Introducing the Node Reporting and Data System 1.0 (Node-RADS): a concept for standardized assessment of lymph nodes in cancer. Eur Radiol 2021; 31:6116-6124. [PMID: 33585994 PMCID: PMC8270876 DOI: 10.1007/s00330-020-07572-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/04/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022]
Abstract
"Node-RADS" addresses the lack of consensus in the radiologic assessment of lymph node involvement by cancer and meets the increasing demand for structured reporting on the likelihood of disease involvement. Node Reporting and Data System 1.0 (Node-RADS) systematically classifies the degree of suspicion of lymph node involvement based on the synthesis of established imaging findings. Straightforward definitions of imaging findings for two proposed scoring categories "size" and "configuration" are combined into assessment categories between 1 ("very low likelihood") and 5 ("very high likelihood"). This scoring system is suitable for assessing likely involvement of lymph nodes on CT and MRI scans. It can be applied at any anatomical site, and to regional and non-regional lymph nodes in relation to a primary tumor location. Node-RADS will improve communication with referring physicians and promote the consistency of reporting for primary staging and in response assessment settings. KEY POINTS: • Node-RADS standardizes reporting of possible cancer involvement of regional and distant lymph nodes on CT and MRI. • Node-RADS proposes the scoring categories "size" and "configuration" for assigning the 5-point Node-RADS score from 1 ("very low likelihood") to 5 ("very high likelihood"). • Node-RADS aims to increase consensus among radiologists for primary staging and in response assessment settings.
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Affiliation(s)
- Fabian H J Elsholtz
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Minerva Becker
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harriet C Thoeny
- Department of Diagnostic and Interventional Radiology, Fribourg Cantonal Hospital, Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
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Driessen DAJJ, Dijkema T, Weijs WLJ, Takes RP, Pegge SAH, Zámecnik P, van Engen-van Grunsven ACH, Scheenen TWJ, Kaanders JHAM. Novel Diagnostic Approaches for Assessment of the Clinically Negative Neck in Head and Neck Cancer Patients. Front Oncol 2021; 10:637513. [PMID: 33634033 PMCID: PMC7901951 DOI: 10.3389/fonc.2020.637513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
In head and neck cancer, the presence of nodal disease is a strong determinant of prognosis and treatment. Despite the use of modern multimodality diagnostic imaging, the prevalence of occult nodal metastases is relatively high. This is why in clinically node negative head and neck cancer the lymphatics are treated “electively” to eradicate subclinical tumor deposits. As a consequence, many true node negative patients undergo surgery or irradiation of the neck and suffer from the associated and unnecessary early and long-term morbidity. Safely tailoring head and neck cancer treatment to individual patients requires a more accurate pre-treatment assessment of nodal status. In this review, we discuss the potential of several innovative diagnostic approaches to guide customized management of the clinically negative neck in head and neck cancer patients.
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Affiliation(s)
- Daphne A J J Driessen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tim Dijkema
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem L J Weijs
- Department of Oral- and Maxillofacial Surgery and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sjoert A H Pegge
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Patrik Zámecnik
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
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Dohopolski M, Chen L, Sher D, Wang J. Predicting lymph node metastasis in patients with oropharyngeal cancer by using a convolutional neural network with associated epistemic and aleatoric uncertainty. Phys Med Biol 2020; 65:225002. [PMID: 33179605 DOI: 10.1088/1361-6560/abb71c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There can be significant uncertainty when identifying cervical lymph node (LN) metastases in patients with oropharyngeal squamous cell carcinoma (OPSCC) despite the use of modern imaging modalities such as positron emission tomography (PET) and computed tomography (CT) scans. Grossly involved LNs are readily identifiable during routine imaging, but smaller and less PET-avid LNs are harder to classify. We trained a convolutional neural network (CNN) to detect malignant LNs in patients with OPSCC and used quantitative measures of uncertainty to identify the most reliable predictions. Our dataset consisted of images of 791 LNs from 129 patients with OPSCC who had preoperative PET/CT imaging and detailed pathological reports after neck dissections. These LNs were segmented on PET/CT imaging and then labeled according to the pathology reports. An AlexNet-like CNN was trained to classify LNs as malignant or benign. We estimated epistemic and aleatoric uncertainty by using dropout variational inference and test-time augmentation, respectively. CNN performance was stratified according to the median epistemic and aleatoric uncertainty values calculated using the validation cohort. Our model achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.99 on the testing dataset. Sensitivity and specificity were 0.94 and 0.90, respectively. Epistemic and aleatoric uncertainty values were statistically larger for false negative and false positive predictions than for true negative and true positive predictions (p < 0.001). Model sensitivity and specificity were 1.0 and 0.98, respectively, for cases with epistemic uncertainty lower than the median value of the incorrect predictions in the validation dataset. For cases with higher epistemic uncertainty, sensitivity and specificity were 0.67 and 0.41, respectively. Model sensitivity and specificity were 1.0 and 0.98, respectively, for cases with aleatoric uncertainty lower than the median value of the incorrect predictions in the validation dataset. For cases with higher aleatoric uncertainty, sensitivity and specificity were 0.67 and 0.37, respectively. We used a CNN to predict the malignant status of LNs in patients with OPSCC with high accuracy, and we showed that uncertainty can be used to quantify a prediction's reliability. Assigning measures of uncertainty to predictions could improve the accuracy of LN classification by efficiently identifying instances where expert evaluation is needed to corroborate a model's prediction.
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Affiliation(s)
- Michael Dohopolski
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, United States of America
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Sananmuang T, Yu E, Su J, O'Sullivan B, Rathod S, Chan B, Bartlett E, Waldron J, Ringash J, Kim J, Bratman SV, Hope A, Spreafico A, Hansen AR, de Almeida J, Goldstein DP, Witterick I, Tong L, Xu W, Huang SH. Pre- and Post-Radiotherapy Radiologic Nodal Features and Oropharyngeal Cancer Outcomes. Laryngoscope 2020; 131:E1162-E1171. [PMID: 33002201 DOI: 10.1002/lary.29045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the prognostic value of pre-/post-radiotherapy (pre-/post-RT) radiologic lymph node (LN) features in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal carcinoma (OPC) patients treated with definitive (chemo-)RT. METHODS Clinical node-positive OPCs treated from 2011 to 2015 were reviewed. Nodal features were reviewed by a radiologist on pre-/post-RT computed tomography (CTs). Univariable analysis calculated hazard ratio (HR) for regional failure (RF), distant metastasis (DM), and deaths. Multivariable analysis estimated adjusted HR (aHR) of significant nodal features identified in univariable analysis adjusting for confounders. RESULTS Pre-RT CT was undertaken in 344 HPV-positive and 94 HPV-negative OPC patients, of whom 242 (70%) HPV-positive and 67 (71%) HPV-negative also had a post-RT CT. Median follow-up was 4.9 years. Pre-RT LN calcification (pre-RT_LN-cal) increased the risk of RF in HPV-negative (aHR: 5.3, P = .007) but not HPV-positive patients (P = .110). Pre-RT radiologic extranodal extension (pre-RT_rENE+) increased the risk of DM and death in both HPV-negative (DM: aHR 6.6, P < .001; death: aHR 2.1, both P = .019) and HPV-positive patients (DM: aHR 4.9; death: aHR 3.0, both P < .001). Increased risk of RF occured with < 20% post-RT LN size reduction in both HPV-negative (HR 6.0, P = .002) and HPV-positive cases (HR 3.0, P = .049). Post-RT_LN-cal did not affect RF, DM, or death regardless of tumor HPV status (all P > .05). CONCLUSION Pre-RT_LN-cal is associated with higher RF risk in HPV-negative but not in HPV-positive patients. Pre-RT_rENE increases risk of DM and death regardless of tumor HPV status. Minimal post-RT LN size reduction (< 20%) increases risk of RF in both diseases. Post-RT_LN-cal + has no apparent influence on outcomes in either disease. LEVEL OF EVIDENCE 4 (a single institution case-control series) Laryngoscope, 131:E1162-E1171, 2021.
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Affiliation(s)
- Thiparom Sananmuang
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine, Ramathibodi Hospital/Mahidol University, Bangkok, Thailand
| | - Eugene Yu
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Shrinivas Rathod
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, CancerCare Manitoba/University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biu Chan
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Eric Bartlett
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Li Tong
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Shao H Huang
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
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Lee S, Lee JY, Yoon RG, Kim JH, Hong HS. The Value of Microvascular Imaging for Triaging Indeterminate Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12102839. [PMID: 33019664 PMCID: PMC7601686 DOI: 10.3390/cancers12102839] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Papillary thyroid carcinomas (PTC) are indolent tumors associated with excellent long-term survival, albeit frequently accompanied by cervical lymph node (LN) metastasis. The imaging criteria using conventional ultrasound (US) techniques showed high diagnostic performance for the suspicious and probably benign LN categories, but showed low diagnostic performance for the indeterminate category. In this retrospective study, we aimed to assess the added value of Superb Microvascular Imaging (SMI) for detecting metastatic PTC in the indeterminate LN category. We confirmed that SMI could effectively stratify indeterminate LNs by visualizing additional vascular signals. The reclassified categories of SMI provided a high diagnostic performance to distinguish metastasis from benign LNs. Therefore, adding SMI to conventional US scans can be useful when evaluating indeterminate LNs in patients with PTC. Abstract Assessment of lymph node (LN) status in patients with papillary thyroid carcinoma (PTC) is often troublesome because of cervical LNs with indeterminate US (ultrasound) features. We aimed to explore whether Superb Microvascular Imaging (SMI) could be helpful for distinguishing metastasis from indeterminate LNs when combined with power Doppler US (PDUS). From 353 consecutive patients with PTC, LNs characterized as indeterminate by PDUS were evaluated by SMI to distinguish them from metastasis. Indeterminate LNs were reclassified according to the SMI, the malignancy risk of each category was assessed, and the diagnostic performance of suspicious findings on SMI was calculated. The incidence of US-indeterminate LNs was 26.9%. Eighty PDUS-indeterminate LNs (39 proven as benign, 41 proven as malignant) were reclassified into probably benign (n = 26), indeterminate (n = 20), and suspicious (n = 34) categories according to SMI, with malignancy risks of 19.2%, 20.0%, and 94.1%, respectively. After combining SMI with PDUS, 80.8% (21/26) of probably benign LNs and 94.1% (32/34) of suspicious LNs could be correctly diagnosed as benign and metastatic, respectively. The diagnostic sensitivity, specificity, and accuracy of categorizing LNs as suspicious based on SMI were 78.1%, 94.9%, and 86.3%, respectively. In conclusion, the combination of SMI with PDUS was helpful for the accurate stratification of indeterminate LNs based on US in patients with PTC.
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Affiliation(s)
- Seongyong Lee
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: ; Tel.: 82-2-2072-3696
| | - Ra Gyoung Yoon
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea;
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Abdelaziz TT, Abdel Razk AAK, Ashour MMM, Abdelrahman AS. Interreader reproducibility of the Neck Imaging Reporting and Data system (NI-RADS) lexicon for the detection of residual/recurrent disease in treated head and neck squamous cell carcinoma (HNSCC). Cancer Imaging 2020; 20:61. [PMID: 32811559 PMCID: PMC7437031 DOI: 10.1186/s40644-020-00337-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background To evaluate the inter- and intrareader agreement and reproducibility of the NI-RADS scoring system and lexicon with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI). Methods This retrospective study included 97 CECT and CEMRI scans from 58 treated cases of head and neck squamous cell carcinoma (HNSCC) after the exclusion of head and neck cancers (HNCs) other than SCC and noncontrast and poor quality CT and MRI scans, with a total of 111 primary targets and 124 lymph node (LN) targets. Two experienced readers independently scored the likelihood of residual/recurrence for these targets based on the NI-RADS criteria and filled in report templates for NI-RADS lexicon diagnostic features. Inter- and intraobserver reproducibility was assessed with Cohen’s kappa, and the percent agreement was calculated. Results Almost perfect interreader agreement was found for the final NI-RADS category of the primary lesions and LNs, with K = 0.808 and 0.806, respectively. Better agreement was found for CT than for MRI (K = 0.843 and 0.77, respectively, P value 0.001). There was almost perfect agreement for excluding tissue enhancement (K = 0.826, 95% CI = 0.658–0.993, P value 0.001), with a percent agreement of 96.4%, and substantial agreement for discrete nodular and diffuse mucosal enhancement (K = 0.826, 95% CI = 0.658–0.993, P value 0.001), with a percent agreement of 96.4%. There was fair agreement for focal mucosal nonmass and deep ill-defined enhancement. The intrareader agreement was almost perfect for most of the rated features (K ranging from 0.802 to 1), with the exception of enlarging discrete nodule/mass and focal mucosal nonmass-like enhancement, which had substantial intraobserver agreement (K ranging from 0.768 to 0.786). Conclusion The individual features of NI-RADS show variable degrees of confidence; however, the overall NI-RADS category was not significantly affected.
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Affiliation(s)
- Tougan Taha Abdelaziz
- Department of diagnostic radiology, faculty of medicine, Ain Shams University, Cairo, Egypt.
| | | | | | - Ahmed S Abdelrahman
- Department of diagnostic radiology, faculty of medicine, Ain Shams University, Cairo, Egypt
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Chinnery T, Arifin A, Tay KY, Leung A, Nichols AC, Palma DA, Mattonen SA, Lang P. Utilizing Artificial Intelligence for Head and Neck Cancer Outcomes Prediction From Imaging. Can Assoc Radiol J 2020; 72:73-85. [PMID: 32735452 DOI: 10.1177/0846537120942134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI)-based models have become a growing area of interest in predictive medicine and have the potential to aid physician decision-making to improve patient outcomes. Imaging and radiomics play an increasingly important role in these models. This review summarizes recent developments in the field of radiomics for AI in head and neck cancer. Prediction models for oncologic outcomes, treatment toxicity, and pathological findings have all been created. Exploratory studies are promising; however, validation studies that demonstrate consistency, reproducibility, and prognostic impact remain uncommon. Prospective clinical trials with standardized procedures are required for clinical translation.
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Affiliation(s)
- Tricia Chinnery
- Department of Medical Biophysics, 6221Western University, London, Ontario, Canada
| | - Andrew Arifin
- Department of Oncology, 6221Western University, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Andrew Leung
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, 6221Western University, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, 6221Western University, London, Ontario, Canada
| | - Sarah A Mattonen
- Department of Medical Biophysics, 6221Western University, London, Ontario, Canada.,Department of Oncology, 6221Western University, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, 6221Western University, London, Ontario, Canada
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Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings. Radiographics 2020; 39:2023-2037. [PMID: 31697616 DOI: 10.1148/rg.2019190109] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.
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Affiliation(s)
| | - Martin Eduardo Renjifo
- From the Department of Radiology, Fundación Valle del Lili-Universidad Icesi, Carrera 98 #18-49, Cali, Colombia
| | - Francisco José Medina
- From the Department of Radiology, Fundación Valle del Lili-Universidad Icesi, Carrera 98 #18-49, Cali, Colombia
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Mahajan A, Ahuja A, Sable N, Stambuk HE. Imaging in oral cancers: A comprehensive review. Oral Oncol 2020; 104:104658. [PMID: 32208340 DOI: 10.1016/j.oraloncology.2020.104658] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Abstract
This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management of oral cavity squamous cell carcinoma (OSCC). Early OSCC can be treated with either surgery alone while advanced cancers are treated with a combination of surgery, radiotherapy and/or chemotherapy. Considering the complex anatomy of the oral cavity and its surrounding structures, imaging plays an indispensable role not only in locoregional staging but also in the distant metastatic work-up and post treatment follow-up. Knowledge of the anatomy with understanding of common routes of spread of cancer, allows the radiologist to accurately determine disease extent and augment clinical findings to plan appropriate therapy. This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India.
| | - Ankita Ahuja
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India
| | - Nilesh Sable
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India
| | - Hilda E Stambuk
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Chaber R, Łasecki M, Kuczyński K, Cebryk R, Kwaśnicka J, Olchowy C, Łach K, Pogodajny Z, Koptiuk O, Olchowy A, Popecki P, Zaleska–Dorobisz U. Hounsfield units and fractal dimension (test HUFRA) for determining PET positive/negative lymph nodes in pediatric Hodgkin's lymphoma patients. PLoS One 2020; 15:e0229859. [PMID: 32191718 PMCID: PMC7082024 DOI: 10.1371/journal.pone.0229859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/16/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives We had developed a method that can help detect and identify lymph nodes affected by the neoplastic process. Our group evaluated the fractal dimension (FD) and X-ray attenuation (XRA) of lymph nodes in HL and compared to their metabolic activity as measured by 18F-FDG-PET examination. Methods The training set included 72 lymph nodes from 31 consecutive patients, and the tested set of 71 lymph nodes from next 19 patients. The measurement of FD of each lymph node was performed before the start of therapy using original software. X-ray attenuation (XRA) expressed in HU (Hounsfield Units) from CT scans was compared with the metabolic activity of the lymphatic nodes, measured by 18F-FDG-PET examination. Results Significant differences were observed between XRAmax and FDmax values in assessing the PET(+) and PET(-) nodes. All nodes were scored from 0 to 2. The HUFRA test properly qualified 95% with a score of 2 and 0 points as PET(+) or PET(-). Conclusion The HUFRA test can differentiate about 70–80% of lymph nodes as PET(+) or PET(-) based solely on the CT examination. It can be useful in patients who were not subjected to 18FFDG-PET/CT examination before the treatment, or who had an unreliable result of 18F-FDG-PET/CT with further research requirements.
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Affiliation(s)
- Radosław Chaber
- Clinic of Pediatric Oncology and Hematology; Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | | | - Karol Kuczyński
- The State School of Higher Education in Chełm, Chełm, Poland
| | - Rafał Cebryk
- Institute of Computer Science, Maria Curie-Sklodowska University, Lublin, Poland
| | - Justyna Kwaśnicka
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Cyprian Olchowy
- Department of Oral Surgery, Wrocław Medical University, Wrocław, Poland
| | - Kornelia Łach
- Clinic of Pediatric Oncology and Hematology; Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Zbigniew Pogodajny
- Affidea Center of Positron Emission Tomography and Computed Tomography, Wrocław, Poland
| | - Olga Koptiuk
- Radiology Department, Lower Silesian Oncology Center in Wrocław, Wrocław, Poland
| | - Anna Olchowy
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Popecki
- Departament of Dental Surgery, Wroclaw Medical University, Wroclaw, Poland
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Garau LM, Rubello D, Muccioli S, Boni G, Volterrani D, Manca G. The sentinel lymph node biopsy technique in papillary thyroid carcinoma: The issue of false-negative findings. Eur J Surg Oncol 2020; 46:967-975. [PMID: 32098735 DOI: 10.1016/j.ejso.2020.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The management of papillary thyroid carcinoma (PTC) is changed after introduction of sentinel lymph node biopsy (SNB) technique for nodal staging. Some debate still surrounds the accuracy of this procedure in terms of wide heterogeneity of sentinel lymph node detection and false-negative findings. AIM to identify the key issues which make it difficult the usefulness of SNB in PTC. METHODS A comprehensive computer literature search of meta-analyses published in PubMed/MEDLINE and Cochrane library database until June 30, 2019 was conducted. We used a search algorithm based on this combination of terms: (i) "thyroid neoplasm" or "thyroid cancer" or "thyroid carcinoma" or "thyroid malignancy" or "meta-analysis" or "systematic review") AND (ii) "sentinel lymph node biopsy". RESULTS Comparing 4 written meta-analyses published in the literature, the diagnostic performance of SNB technique in PTC has been summarized. Relatively high false-negative rates (FNR) were reported for each SNB methods: vital-dye (VD: 12.7%; 7%; 0-38%), 99mTc-nanocolloid planar lymphoscintigraphy with the use of intraoperative hand-held gamma probes (LS: 11.3%; 16%; 0-40%), combined LS with VD (LS+VD: 0%; 0-17%), LS with the additional contribution of preoperative SPECT/CT (7-8%). CONCLUSION Evidence-based data about the diagnostic performance of SNB in PTC are increasing. The nuclear medicine community should reach a consensus on the operational definition of the SLN to better guide the surgeon in identifying the lymph nodes most likely contain metastatic cells. Standardization of SLN identification, removal and analysis are required.
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Affiliation(s)
- Ludovico M Garau
- Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa, Italy.
| | - Domenico Rubello
- Nuclear Medicine and PET Centre, Santa Maria della Misericordia Hospital, Rovigo, Italy.
| | - Simona Muccioli
- Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa, Italy
| | - Giuseppe Boni
- Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa, Italy
| | - Gianpiero Manca
- Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa, Italy
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Samanci C, Onal Y, Sager S, Asa S, Ustabasioglu FE, Alis D, Akman C, Sonmezoglu K. Diagnostic Capabilities of MRI Versus 18F FDG PET-CT in Postoperative Patients with Thyroglobulin Positive, 131I-negative Local Recurrent or Metastatic Thyroid Cancer. Curr Med Imaging 2020; 15:956-964. [PMID: 32008523 DOI: 10.2174/1573405614666180718124739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/12/2018] [Accepted: 06/29/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The detection of recurrence or metastasis might be challenging in patients, who underwent total thyroidectomy and radioactive iodine therapy for Differentiated Thyroid Carcinoma (DTC), with increased serum Thyroglobulin (Tg) levels and negative 131I whole body scan (131I-WBS) results. AIMS The purpose of this study was to compare the ability of Magnetic Resonance Imaging (MRI) and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F FDG PET-CT) to detect recurrence or cervical and upper mediastinal metastases in postoperative DTC patients who had negative 131I-WBS despite elevated serum Tg levels. STUDY DESIGN This study has a retrospective study design. METHODS We evaluated cervical and upper mediastinal MRI and 18F FDG PET-CT of 32 postoperative patients with DTC (26 patients with papillary thyroid carcinoma and 6 patients with follicular thyroid carcinoma). RESULTS We evaluated 44 lesions in 32 patients. For all lesions, the Positive Predictive Value, (PPV) Negative Predictive Value (NPV), sensitivity, specificity, and accuracy of MRI were 81.4%, 76.4%, 84.6%, 72.2%, and 79.5% respectively. The PPV, NPV, sensitivity, specificity, and accuracy of 18F FDG PET-CT were 100.0%, 85.7%, 88.4%, 100.0%, and 93.1%, respectively. CONCLUSION Although we could not replace 18F FDG PET-CT, MRI might be used as an adjunct to 18F FDG PET-CT for the evaluation of recurrent or cervical and upper mediastinal metastatic thyroid cancers; however, MRI is inadequate for the detection of metastases in small lymph nodes.
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Affiliation(s)
- Cesur Samanci
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yilmaz Onal
- Department of Radiology, İstanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sait Sager
- Department of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sertac Asa
- Department of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fethi Emre Ustabasioglu
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Canan Akman
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Department of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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