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Margalit DN, Anker CJ, Aristophanous M, Awan M, Bajaj GK, Bradfield L, Califano J, Caudell JJ, Chapman CH, Garden AS, Harari PM, Helms A, Lin A, Maghami E, Mehra R, Parker L, Shnayder Y, Spencer S, Swiecicki PL, Tsai JC, Sher DJ. Radiation Therapy for HPV-Positive Oropharyngeal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2024:S1879-8500(24)00139-5. [PMID: 39078350 DOI: 10.1016/j.prro.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct disease from other head and neck tumors. This guideline provides evidence-based recommendations on the critical decisions in its curative treatment, including both definitive and postoperative radiation therapy (RT) management. METHODS ASTRO convened a task force to address 5 key questions on the use of RT for management of HPV-associated OPSCC. These questions included indications for definitive and postoperative RT and chemoradiation; dose-fractionation regimens and treatment volumes; preferred RT techniques and normal tissue considerations; and posttreatment management decisions. The task force did not address indications for primary surgery versus RT. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS Concurrent cisplatin is recommended for patients receiving definitive RT with T3-4 disease and/or 1 node >3 cm, or multiple nodes. For similar patients who are ineligible for cisplatin, concurrent cetuximab, carboplatin/5-fluorouracil, or taxane-based systemic therapy are conditionally recommended. In the postoperative setting, RT with concurrent cisplatin (either schedule) is recommended for positive surgical margins or extranodal extension. Postoperative RT alone is recommended for pT3-4 disease, >2 nodes, or a single node >3 cm. Observation is conditionally recommended for pT1-2 disease and a single node ≤3 cm without other risk factors. For patients treated with definitive RT with concurrent systemic therapy, 7000 cGy in 33 to 35 fractions is recommended, and for patients receiving postoperative RT without positive surgical margins and extranodal extension, 5600 to 6000 cGy is recommended. For all patients receiving RT, intensity modulated RT over 3-dimensional techniques with reduction in dose to critical organs at risk (including salivary and swallowing structures) is recommended. Reassessment with positron emission tomography-computed tomography is recommended approximately 3 months after definitive RT/chemoradiation, and neck dissection is recommended for convincing evidence of residual disease; for equivocal positron emission tomography-computed tomography findings, either neck dissection or repeat imaging is recommended. CONCLUSIONS The role and practice of RT continues to evolve for HPV-associated OPSCC, and these guidelines inform best clinical practice based on the available evidence.
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Affiliation(s)
- Danielle N Margalit
- Department of Radiation Oncology, Brigham & Women's/Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts.
| | - Christopher J Anker
- Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont
| | - Michalis Aristophanous
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gopal K Bajaj
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Joseph Califano
- Department of Surgery, University of California San Diego Health, San Diego, California
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Christina H Chapman
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas - MD Anderson Cancer Center, Houston, Texas
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
| | - Amanda Helms
- American Society for Radiation Oncology, Arlington, Virginia
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellie Maghami
- Department of Surgery, City of Hope, Duarte, California
| | - Ranee Mehra
- Department of Medical Oncology, University of Maryland Medical School and Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama Heersink School of Medicine, Birmingham, Alabama
| | - Paul L Swiecicki
- Department of Medical Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | | | - David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Hiyama T, Miyasaka Y, Kuno H, Sekiya K, Sakashita S, Shinozaki T, Kobayashi T. Posttreatment Head and Neck Cancer Imaging: Anatomic Considerations Based on Cancer Subsites. Radiographics 2024; 44:e230099. [PMID: 38386602 DOI: 10.1148/rg.230099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Posttreatment imaging surveillance of head and neck cancer is challenging owing to complex anatomic subsites and diverse treatment modalities. Early detection of residual disease or recurrence through surveillance imaging is crucial for devising optimal treatment strategies. Posttreatment imaging surveillance is performed using CT, fluorine 18-fluorodeoxyglucose PET/CT, and MRI. Radiologists should be familiar with postoperative imaging findings that can vary depending on surgical procedures and reconstruction methods that are used, which is dictated by the primary subsite and extent of the tumor. Morphologic changes in normal structures or denervation of muscles within the musculocutaneous flap may mimic recurrent tumors. Recurrence is more likely to occur at the resection margin, margin of the reconstructed flap, and deep sites that are difficult to access surgically. Radiation therapy also has a varying dose distribution depending on the primary site, resulting in various posttreatment changes. Normal tissues are affected by radiation, with edema and inflammation occurring in the early stages and fibrosis in the late stages. Distinguishing scar tissue from residual tumor becomes necessary, as radiation therapy may leave behind residual scar tissue. Local recurrence should be carefully evaluated within areas where these postradiation changes occur. Head and Neck Imaging Reporting and Data System (NI-RADS) is a standardized reporting and risk classification system with guidance for subsequent management. Familiarity with NI-RADS has implications for establishing surveillance protocols, interpreting posttreatment images, and management decisions. Knowledge of posttreatment imaging characteristics of each subsite of head and neck cancers and the areas prone to recurrence empowers radiologists to detect recurrences at early stages. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Takashi Hiyama
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Yusuke Miyasaka
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Hirofumi Kuno
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Kotaro Sekiya
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Shingo Sakashita
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Takeshi Shinozaki
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Tatsushi Kobayashi
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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3
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Paul S, Gupta T, Purandare N, Joshi K, Ghosh-Laskar S, Budrukkar A, Swain M, Sinha S, Kumar A, Joshi A, Prabhash K, Nair S, Rangarajan V, Agarwal JP. Diagnostic Performance of Response Assessment FDG-PET/CECT in HNSCC Treated With Definitive Radio(chemo)therapy Using NI-RADS. Otolaryngol Head Neck Surg 2023; 169:938-947. [PMID: 36856038 DOI: 10.1002/ohn.305] [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: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To assess the diagnostic performance of response assessment 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (FDG-PET/CECT) following definitive radio(chemo)therapy in head and neck squamous cell carcinoma (HNSCC) using Neck Imaging Reporting and Data System (NI-RADS). STUDY DESIGN A retrospective analysis from a prospectively maintained dataset. SETTING Tertiary-care comprehensive cancer center in a low-middle-income country. METHODS Adults with newly diagnosed, biopsy-proven, nonmetastatic HNSCC treated with definitive radio(chemo)therapy were included. Posttreatment response assessment FDG-PET/CECT scans were retrospectively assigned NI-RADS categories (1-3) for the primary site, neck, and both sites combined. Locoregional recurrence occurring within 2-years was defined as the event of interest. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Locoregional control stratified by NI-RADS categories was computed with the Kaplan-Meier method and compared using the log-rank test. RESULTS Posttreatment FDG-PET/CECT scans were available in 190 patients constituting the present study cohort. Sensitivity, specificity, PPV, NPV, and overall accuracy of the NI-RADS template for the primary site was 73.5%, 81.4%, 46.3%, 93.4%, and 80.0%, respectively. Similar metrics for the neck were 72.7%, 87.5%, 43.2%, 96.1%, and 85.8%, respectively. Combining primary site and neck, the corresponding metrics of diagnostic accuracy were 84.4%, 69.7%, 46.3%, 93.5%, and 73.2%, respectively. At a median follow-up of 40 months, Kaplan-Meier estimates of 2-year locoregional control were significantly higher for NI-RADS category 1 (94.2%) compared to NI-RADS category 2 (69.4%) and category 3 (20.4%), respectively (stratified log-rank p < .0001). CONCLUSION FDG-PET/CECT using the NI-RADS template is associated with good diagnostic performance and prognostic utility in HNSCC treated with definitive radio(chemo)therapy.
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Affiliation(s)
- Sonz Paul
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kishore Joshi
- Department of Medical Physics, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Hanna GJ, Patel N, Tedla SG, Baugnon KL, Aiken A, Agrawal N. Personalizing Surveillance in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e389718. [PMID: 37079869 DOI: 10.1200/edbk_389718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) encompasses a spectrum of heterogeneous diseases originating in the oral cavity, pharynx, and larynx. Within the United States, head and neck cancer (HNC) accounts for 66,470 new cases, or 3% of all malignancies, annually.1 The incidence of HNC is rising, largely driven by increases in oropharyngeal cancer.2-4 Recent molecular and clinical advancements, particularly with regard to molecular and tumor biology, reflect the heterogeneity of the subsites contained within the head and neck. Despite this, existing guidelines for post-treatment surveillance remain broad without much consideration given to different anatomic subsites and etiologic factors (such as human papillomavirus [HPV] status or tobacco exposure).5 Surveillance incorporating the physical examination, imaging, and emerging molecular biomarkers is an essential part of care for patients treated for HNC and allows for the detection of locoregional recurrence, distant metastases, and second primary malignancies aiming for better functional and survival outcomes. Additionally, it allows for evaluation and management of post-treatment complications.
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Affiliation(s)
- Glenn J Hanna
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Nirali Patel
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
| | - Sara G Tedla
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Nishant Agrawal
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
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Landin D, Näsman A, Jara SJ, Hammarstedt-Nordenvall L, Munck-Wikland E, Dalianis T, Marklund L. Post-Treatment Neck Dissection of Tonsillar and Base of Tongue Squamous Cell Carcinoma in the Era of PET-CT, HPV, and p16. Viruses 2022; 14:v14081693. [PMID: 36016315 PMCID: PMC9413897 DOI: 10.3390/v14081693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Human-papillomavirus (HPV)-positive tonsillar and base of tongue carcinomas (TSCC/BOTSCC) are rising in incidence and treatments with radiotherapy, chemoradiotherapy (RT/CRT), and neck dissections (NDs) have several side effects. Therefore, an improved selection of patients needing salvage NDs would be beneficial. We examined the prevalence and localisations of viable tumour cells in neck lymph nodes in patients post-RT/CRT, identified by fluorodeoxyglucose positron-emission tomography with computer-tomography (FDG PET-CT), with a focus on HPV-associated tumours. Patients with 217 TSCC/BOTSCC with tumours assessed for HPV-DNA and p16INK4a undergoing FDG PET-CT 12 weeks after treatment and/or an ND were included. The FDG PET-CT data were compared with the findings in the pathology report after the ND. In total, 36/217 (17%) patients were selected for an ND due to positive findings in post-treatment FDG PET-CT. Of these, 35/36 were HPV-associated, 10/36 (28%) had viable tumour cells in the pathology reports of the neck specimen, and 8/10 (80%) were consistent with the FDG PET-CT findings, while 2/36 (5%) were missed by FDG PET-CT. We conclude that FDG PET-CT 12 weeks after RT/CRT is useful, but not completely reliable for finding all the metastases of HPV-associated TSCC/BOTSCC. Nonetheless, our data indicate that an ND could be more selectively guided by FDG PET-CT.
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Affiliation(s)
- David Landin
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology, Pathology, Karolinska Institute, 17164 Stockholm, Sweden;
- Department of Clinical Pathology, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Sara Jonmarker Jara
- Department of Neuroradiology, Karolinska University Hospital, 17164 Stockholm, Sweden;
| | - Lalle Hammarstedt-Nordenvall
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology, Pathology, Karolinska Institute, 17164 Stockholm, Sweden;
- Correspondence: (T.D.); (L.M.)
| | - Linda Marklund
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, 75105 Uppsala, Sweden
- Correspondence: (T.D.); (L.M.)
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Wiggins RH, Hoffman JM, Fine GC, Covington MF, Salem AE, Koppula BR, Morton KA. PET-CT in Clinical Adult Oncology-V. Head and Neck and Neuro Oncology. Cancers (Basel) 2022; 14:cancers14112726. [PMID: 35681709 PMCID: PMC9179458 DOI: 10.3390/cancers14112726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Positron emission tomography (PET), typically combined with computed tomography (CT) has become a critical advanced imaging technique in oncology. With PET-CT, a radioactive molecule (radiotracer) is injected in the bloodstream and localizes to sites of tumor because of specific cellular features of the tumor that accumulate the targeting radiotracer. The CT scan, performed at the same time, provides information to facilitate attenuation correction, so that radioactivity from deep or dense structures can be better visualized, but with head and neck malignancies it is critical to provide correlating detailed anatomic imaging. PET-CT has a variety of applications in oncology, including staging, therapeutic response assessment, restaging, and surveillance. This series of six review articles provides an overview of the value, applications, and imaging and interpretive strategies of PET-CT in the more common adult malignancies. The fifth report in this series provides a review of PET-CT imaging in head and neck and neuro oncology. Abstract PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging, and longitudinal surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, and the potential pitfalls and nuances that characterize these applications. In addition, key tumor-specific clinical information and representative PET-CT images are provided to outline the role that PET-CT plays in the management of oncology patients. Hundreds of different types of tumors exist, both pediatric and adult. A discussion of the role of FDG PET for all of these is beyond the scope of this review. Rather, this series of articles focuses on the most common adult malignancies that may be encountered in clinical practice. It also focuses on FDA-approved and clinically available radiopharmaceuticals, rather than research tracers or those requiring a local cyclotron. The fifth review article in this series focuses on PET-CT imaging in head and neck tumors, as well as brain tumors. Common normal variants, key anatomic features, and benign mimics of these tumors are reviewed. The goal of this review article is to provide the imaging professional with guidance in the interpretation of PET-CT for the more common head and neck malignancies and neuro oncology, and to inform the referring providers so that they can have realistic expectations of the value and limitations of PET-CT for the specific type of tumor being addressed.
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Affiliation(s)
- Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
- Intermountain Healthcare Hospitals, Summit Physician Specialists, Murray, UT 84123, USA
- Correspondence: ; Tel.: +1-801-581-7553
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7
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Patel L, Bridgham K, Ciriello J, Almardawi R, Leon J, Hostetter J, Yazbek S, Raghavan P. PET/MR Imaging in Evaluating Treatment Failure of Head and Neck Malignancies: A Neck Imaging Reporting and Data System-Based Study. AJNR Am J Neuroradiol 2022; 43:435-441. [PMID: 35177543 PMCID: PMC8910793 DOI: 10.3174/ajnr.a7427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PET/MR imaging is a relatively new hybrid technology that holds great promise for the evaluation of head and neck cancer. The aim of this study was to assess the performance of simultaneous PET/MR imaging versus MR imaging in the evaluation of posttreatment head and neck malignancies, as determined by its ability to predict locoregional recurrence or progression after imaging. MATERIALS AND METHODS The electronic medical records of patients who had posttreatment PET/MR imaging studies were reviewed, and after applying the exclusion criteria, we retrospectively included 46 studies. PET/MR imaging studies were independently reviewed by 2 neuroradiologists, who recorded scores based on the Neck Imaging Reporting and Data System (using CT/PET-CT criteria) for the diagnostic MR imaging sequences alone and the combined PET/MR imaging. Treatment failure was determined with either biopsy pathology or initiation of new treatment. Statistical analyses including univariate association, interobserver agreement, and receiver operating characteristic analysis were performed. RESULTS There was substantial interreader agreement among PET/MR imaging scores (κ = 0.634; 95% CI, 0.605-0.663). PET/MR imaging scores showed a strong association with treatment failure by univariate association analysis, with P < .001 for the primary site, neck lymph nodes, and combined sites. Receiver operating characteristic curves of PET/MR imaging scores versus treatment failure indicated statistically significant diagnostic accuracy (area under curve range, 0.864-0.987; P < .001). CONCLUSIONS Simultaneous PET/MR imaging has excellent discriminatory performance for treatment outcomes of head and neck malignancy when the Neck Imaging Reporting and Data System is applied. PET/MR imaging could play an important role in surveillance imaging for head and neck cancer.
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Affiliation(s)
- L.D. Patel
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - K. Bridgham
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Ciriello
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - R. Almardawi
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Leon
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Hostetter
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - S. Yazbek
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - P. Raghavan
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
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Baugnon KL. NI-RADS to Predict Residual or Recurrent Head and Neck Squamous Cell Carcinoma. Neuroimaging Clin N Am 2021; 32:1-18. [PMID: 34809832 DOI: 10.1016/j.nic.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
American College of Radiology NI-RADS is a surveillance imaging template used to predict residual or recurrent tumor in the setting of head and neck cancer. The lexicon and imaging template provides a framework to standardize the interpretations and communications with referring physicians and provides linked management recommendations, which add value in patient care. Studies have shown reasonable interreader agreement and excellent discriminatory power among the different NI-RADS categories. This article reviews the literature associated with NI-RADS and serves as a practical guide for radiologists interested in using the NI-RADS surveillance template at their institution, highlighting frequently encountered pearls and pitfalls.
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Affiliation(s)
- Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Head and Neck Imaging, Emory University, 1364 Clifton Road, Atlanta, GA 30322, USA.
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Bunch PM, Meegalla NT, Abualruz AR, Frizzell BA, Patwa HS, Porosnicu M, Williams DW, Aiken AH, Hughes RT. Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System. Laryngoscope 2021; 132:349-355. [PMID: 34272871 DOI: 10.1002/lary.29765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system developed for head and neck cancer surveillance imaging, using standardized terminology, numeric levels of suspicion, and linked management recommendations. Through a multidisciplinary, interdepartmental quality improvement initiative, we implemented NI-RADS for the reporting of head and neck cancer surveillance CT. Our objective is to summarize our initial experience from the standpoints of head and neck cancer providers and radiologists. STUDY DESIGN Quality improvement study. METHODS Before and 3 months post-implementation, surveys were offered to referring physicians (n = 21 pre-adoption; 22 post-adoption) and radiologists (n = 17 pre- and post-adoption). NI-RADS utilization was assessed over time. RESULTS Survey response rates were 62% (13/21) and 73% (16/22) for referring physicians pre- and post-adoption, respectively, and 94% (16/17) for radiologists pre- and post-adoption. Among post-adoption provider respondents, 100% (16/16) strongly agreed or agreed with "I want our radiologists to continue using NI-RADS," "The NI-RADS numerical rating of radiologic suspicion is helpful," and "The language and style of NI-RADS neck CT reports are clear and understandable." Among radiologist respondents, 88% (14/16) strongly agreed or agreed with "NI-RADS improves consistency among our radiologists in the reporting of surveillance neck CTs." Radiologist NI-RADS utilization increased over time (46% month 1; 72% month 3). CONCLUSIONS Most referring physicians and radiologists preferred NI-RADS. Head and neck cancer providers indicated that NI-RADS reports are clear, understandable, direct, and helpful in guiding clinical management. Radiologists indicated that NI-RADS improves radiologist consistency in the reporting of surveillance neck CT, and radiologists increasingly used NI-RADS over time. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2021.
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Affiliation(s)
- Paul M Bunch
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Nuwan T Meegalla
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Abdul-Rahman Abualruz
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Bart A Frizzell
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Hafiz S Patwa
- Department of Otolaryngology - Head and Neck Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Mercedes Porosnicu
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Daniel W Williams
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Ashley H Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
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Ashour MM, Darwish EAF, Fahiem RM, Abdelaziz TT. MRI Posttreatment Surveillance for Head and Neck Squamous Cell Carcinoma: Proposed MR NI-RADS Criteria. AJNR Am J Neuroradiol 2021; 42:1123-1129. [PMID: 33707288 DOI: 10.3174/ajnr.a7058] [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: 06/28/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE The current Neck Imaging Reporting and Data System (NI-RADS) criteria were designed for contrast-enhanced CT with or without PET. Prior studies have revealed the capability of DWI and T2 signal intensity in distinguishing locoregional tumor residual and recurrence from posttreatment benign findings in head and neck cancers. We aimed to propose MR imaging NI-RADS criteria by adding diffusion criteria and T2 signal intensity to the American College of Radiology NI-RADS template. MATERIALS AND METHODS This retrospective study included 69 patients with head and neck squamous cell carcinoma (HNSCC) who underwent posttreatment contrast-enhanced MRI imaging surveillance using a 1.5T scanner. The scans were interpreted by 2 neuroradiologists. Image analysis assessed the primary tumor site using the current American College of Radiology NI-RADS morphologic lexicon (mainly designed for contrast-enhanced CT with or without PET). NI-RADS rescoring was then performed based on our proposed criteria using T2 signal and diffusion features. The reference standard was a defined set of criteria, including clinical and imaging follow-up and pathologic assessment. RESULTS Imaging assessment of treated HNSCC at the primary tumor site using T2 signal intensity and diffusion features as modifying rules to NI-RADS showed higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (92.3%, 90.7%, 85.7%, 95.1%, and 91.3%, respectively) compared with the current NI-RADS lexicon alone (84.6%, 81.4%, 73.3%, 89.8%, and 82.6%, respectively). CONCLUSIONS The addition of diffusion features and T2 signal to the American College of Radiology NI-RADS criteria for the primary tumor site enhances the specificity, sensitivity, positive predictive value, negative predictive value, and NI-RADS accuracy.
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Affiliation(s)
- M M Ashour
- From the Department of Diagnostic Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - E A F Darwish
- From the Department of Diagnostic Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R M Fahiem
- From the Department of Diagnostic Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - T T Abdelaziz
- From the Department of Diagnostic Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Retrospective Evaluation of NI-RADS for Detecting Postsurgical Recurrence of Oral Squamous Cell Carcinoma on Surveillance CT or MRI. AJR Am J Roentgenol 2021; 217:198-206. [DOI: 10.2214/ajr.20.24209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hsu D, Rath TJ, Branstetter BF, Anzai Y, Phillips CD, Juliano AF, Mosier KM, Bazylewicz MP, Poliashenko SM, Kulzer MH, Rhyner PA, Risk B, Wiggins RH, Aiken AH. Interrater Reliability of NI-RADS on Posttreatment PET/Contrast-enhanced CT Scans in Head and Neck Squamous Cell Carcinoma. Radiol Imaging Cancer 2021; 3:e200131. [PMID: 34018845 DOI: 10.1148/rycan.2021200131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose To evaluate the interrater reliability among radiologists examining posttreatment head and neck squamous cell carcinoma (HNSCC) fluorodeoxyglucose PET/contrast-enhanced CT (CECT) scans using Neck Imaging Reporting and Data System (NI-RADS). Materials and Methods In this retrospective study, images in 80 patients with HNSCC who underwent posttreatment surveillance PET/CECT and immediate prior comparison CECT or PET/CECT (from June 2014 to July 2016) were uploaded to the American College of Radiology's cloud-based website, Cortex. Eight radiologists from seven institutions with variable NI-RADS experience independently evaluated each case and assigned an appropriate prose description and NI-RADS category for the primary site and the neck site. Five of these individuals were experienced readers (> 5 years of experience), and three were novices (< 5 years of experience). In total, 640 lexicon-based and NI-RADS categories were assigned to lesions among the 80 included patients by the eight radiologists. Light generalization of Cohen κ for interrater reliability was performed. Results Of the 80 included patients (mean age, 63 years ± 10 [standard deviation]), there were 58 men (73%); 60 patients had stage IV HNSCC (75%), and the most common tumor location was oropharynx (n = 32; 40%). Light κ for lexicon was 0.30 (95% CI: 0.23, 0.36) at the primary site and 0.31 (95% CI: 0.24, 0.37) at the neck site. Light κ for NI-RADS category was 0.55 (95% CI: 0.46, 0.63) at the primary site and 0.60 (95% CI: 0.48, 0.69) at the neck site. Percent agreement between lexicon and correlative NI-RADS category was 84.4% (540 of 640) at the primary site and 92.6% (593 of 640) at the neck site. There was no significant difference in interobserver agreement among the experienced versus novice raters. Conclusion Moderate agreement was achieved among eight radiologists using NI-RADS at posttreatment HNSCC surveillance imaging. Keywords: CT, PET/CT, Head/Neck, Neck, Neoplasms-Primary, Observer Performance Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Derek Hsu
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Tanya J Rath
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Barton F Branstetter
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Yoshimi Anzai
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - C Douglas Phillips
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Amy F Juliano
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Kristine M Mosier
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Michael P Bazylewicz
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Stan M Poliashenko
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Matthew H Kulzer
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Patricia A Rhyner
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Benjamin Risk
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Richard H Wiggins
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
| | - Ashley H Aiken
- From the Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Room BG03, Atlanta, GA 30322 (D.H., A.H.A.); Department of Neuroradiology, Mayo Clinic, Phoenix, Ariz (T.J.R.); Departments of Radiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (B.F.B.); Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah (Y.A., R.H.W.); Department of Neuroradiology, Weill Cornell Imaging at New York-Presbyterian, New York, NY (C.D.P.); Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass (A.F.J.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (K.M.K.); Department of Radiology, University of Vermont Medical Center, Burlington, Vt (M.P.B.); Radiology Imaging Associates, Englewood, Colo (S.M.P.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.H.K.); Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga (P.A.R.); and Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Ga (B.R.)
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Best Practices: Application of NI-RADS for Posttreatment Surveillance Imaging of Head and Neck Cancer. AJR Am J Roentgenol 2021; 216:1438-1451. [PMID: 32876470 DOI: 10.2214/ajr.20.23841] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imaging surveillance is an important component of posttreatment management of head and neck cancers. There is variability in the surveillance regimen used by various practitioners and institutions, with no official National Comprehensive Cancer Network guidelines for patients showing no symptoms beyond 6 months posttreatment. Moreover, imaging of the neck after treatment is a complex examination with significant interreader heterogeneity, particularly in terms of the manner in which degree of suspicion for disease recurrence is expressed. The Neck Imaging Reporting and Data System (NI-RADS) was introduced by the American College of Radiology (ACR) in 2018 as a practical guide for the interpreting radiologist. NI-RADS is a proposed interpretive framework that can be applied to any standardized or institutional surveillance imaging protocol. NI-RADS simplifies communication between radiologists and referring clinicians and provides management guidance linked to specific levels of suspicion. The ACR NI-RADS Committee also provided general best practice recommendations for imaging surveillance modality and timing in the 2018 white paper. This article will review existing literature regarding choice of modality and timeline for surveillance in treated cancer of the head and neck. NI-RADS will then be presented as an approach to imaging reporting, interpretation, and design of next steps in management.
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Positron Emission Tomography and Molecular Imaging of Head and Neck Malignancies. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00366-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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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16
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Gillespie J. Imaging of the post-treatment neck. Clin Radiol 2020; 75:794.e7-794.e17. [PMID: 32690240 DOI: 10.1016/j.crad.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
Post-treatment imaging of the neck is complex. It is important to have an understanding of the expected treatment related appearances as well as the possible complications. Common findings after radiation therapy include generalised soft-tissue oedema and thickening of the skin and platysma muscle. There are a number of complications of radiation that may be seen on imaging, including osteoradionecrosis, chondronecrosis, and accelerated atherosclerosis. Surgical procedures are variable depending on the primary tumour site and extent. The use of flap reconstructions can further complicate the imaging appearances. Any new nodule of enhancement or bone/cartilage erosion should raise concern for tumour recurrence. It is also important to assess for nodal recurrence. A standardised approach to reporting may help to increase accuracy and guide treatment decisions.
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Affiliation(s)
- J Gillespie
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia; Faculty of Medicine, University of Queensland, Level 6, Oral Health Centre, Herston Road, Herston, QLD, 4006 Australia.
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17
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Gore A, Baugnon K, Beitler J, Saba NF, Patel MR, Wu X, Boyce BJ, Aiken AH. Posttreatment Imaging in Patients with Head and Neck Cancer without Clinical Evidence of Recurrence: Should Surveillance Imaging Extend Beyond 6 Months? AJNR Am J Neuroradiol 2020; 41:1238-1244. [PMID: 32554418 DOI: 10.3174/ajnr.a6614] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of residual or recurrent disease is important for effective salvage treatment in patients with head and neck cancer. Current National Comprehensive Cancer Network guidelines do not recommend standard surveillance imaging beyond 6 months unless there are worrisome signs or symptoms on clinical examination and offer vague guidelines for imaging of high-risk patients beyond that timeframe. Our goal was to evaluate the frequency of clinically occult recurrence in patients with head and neck squamous cell carcinoma with positive imaging findings (Neck Imaging Reporting and Data Systems scores of 2-4), especially after 6 months. MATERIALS AND METHODS This institutional review board-approved, retrospective data base search queried neck CT reports with Neck Imaging Reporting and Data Systems scores of 2-4 from June 2014 to March 2018. The electronic medical records were reviewed to determine outcomes of clinical and radiologic follow-up, including symptoms, physical examination findings, pathologic correlation, and clinical notes within 3 months of imaging. RESULTS A total of 255 cases, all with Neck Imaging Reporting and Data Systems scores of 2 or 3, met the inclusion criteria. Fifty-nine patients (23%) demonstrated recurrence (45 biopsy-proven, 14 based on clinical and imaging progression), and 21 patients (36%) had clinically occult recurrence (ie, no clinical evidence of disease at the time of the imaging examination). The median overall time to radiologically detected, clinically occult recurrence was 11.4 months from treatment completion. CONCLUSIONS Imaging surveillance beyond the first posttreatment baseline study was critical for detecting clinically occult recurrent disease in patients with head and neck squamous cell carcinoma. More than one-third of all recurrences were seen in patients without clinical evidence of disease; and 81% of clinically occult recurrences occurred beyond 6 months.
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Affiliation(s)
- A Gore
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - K Baugnon
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | | | - N F Saba
- Hematology/Oncology (N.F.S.).,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - M R Patel
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - X Wu
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - B J Boyce
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.) .,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
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18
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Hsu D, Juliano AF. Neck Imaging Reporting and Data System: Principles and Implementation. Neuroimaging Clin N Am 2020; 30:369-377. [PMID: 32600637 DOI: 10.1016/j.nic.2020.05.001] [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] [Indexed: 11/16/2022]
Abstract
Head and neck cancer surveillance imaging is diagnostically challenging, often with highly distorted anatomy after surgery and chemoradiation therapy. In the era of standardized reporting, the Neck Imaging Reporting and Data System (NI-RADS) was developed as a numerical classification system to provide clear and concise radiology reports and recommend next management step. There are 5 categories, each conveying a certain level of suspicion for the presence of persistent or recurrent disease. This article reviews the goals of NI-RADS, NI-RADS categories and lexicon, current research, and the future direction of NI-RADS in posttreatment head and neck cancer surveillance.
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Affiliation(s)
- Derek Hsu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG03, Atlanta, GA 30322, USA.
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA. https://twitter.com/amyfjuliano
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19
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Wangaryattawanich P, Branstetter BF, Ly JD, Duvvuri U, Heron DE, Rath TJ. Positive Predictive Value of Neck Imaging Reporting and Data System Categories 3 and 4 Posttreatment FDG-PET/CT in Head and Neck Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2020; 41:1070-1075. [PMID: 32467187 DOI: 10.3174/ajnr.a6589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The Neck Imaging Reporting and Data System is a standardized reporting system intended to risk stratify patients treated for head and neck squamous cell carcinoma. The purpose of this study is to investigate the positive predictive value of the Neck Imaging Reporting and Data System categories 3 and 4 on posttreatment PET/CT in patients treated definitively for head and neck squamous cell carcinoma. MATERIALS AND METHODS We retrospectively identified patients treated definitively for head and neck squamous cell carcinoma between 2006 and 2018. Patients whose posttreatment PET/CT scans were interpreted as Neck Imaging Reporting and Data System 3 (suspicious) or 4 (definitive recurrence) at the primary site, regional nodes, or at distant sites were included. The reference standard was histopathology or unequivocal imaging or clinical evidence of treatment failure. The positive predictive values of Neck Imaging Reporting and Data System 3 and 4 posttreatment PET/CT were calculated. RESULTS Seventy-two of 128 patients with posttreatment PET/CT interpreted as Neck Imaging Reporting and Data System 3 at the primary site, regional nodes, or distant sites were proved to have treatment failure at the suspicious sites, yielding an overall positive predictive value of 56% (95% CI, 48%-65%). The positive predictive values of Neck Imaging Reporting and Data System 3 by subsite were as follows: primary site, 56% (44/79); regional nodes, 65% (34/52); and distant sites, 79% (42/53). All 69 patients with posttreatment PET/CT interpreted as Neck Imaging Reporting and Data System 4 had true treatment failure, yielding a positive predictive value of 100% (95% CI, 96%-100%): primary site, 100% (28/28); regional nodes, 100% (32/32); and distant sites, 100% (29/29). CONCLUSIONS The positive predictive value of Neck Imaging Reporting and Data System 3 on posttreatment PET/CT is relatively low. Thus, Neck Imaging Reporting and Data System 3 findings should be confirmed with tissue sampling before instituting new salvage treatment regimens to avoid unnecessary overtreatment and its associated toxicities. Neck Imaging Reporting and Data System 4 reliably indicates recurrent disease.
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Affiliation(s)
| | - B F Branstetter
- From the Departments of Radiology (P.W., B.F.B., J.D.L.).,Otolaryngology (B.F.B., U.D., D.E.H.).,Biomedical Informatics (B.F.B.)
| | - J D Ly
- From the Departments of Radiology (P.W., B.F.B., J.D.L.)
| | - U Duvvuri
- Otolaryngology (B.F.B., U.D., D.E.H.)
| | - D E Heron
- Otolaryngology (B.F.B., U.D., D.E.H.).,Radiation Oncology (D.E.H.), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - T J Rath
- Neuroradiology Section, Department of Radiology (T.J.R.), Mayo Clinic Hospital, Phoenix, Arizona.
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20
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Neck Imaging Reporting and Data System: What Does Radiologist Want to Know? J Comput Assist Tomogr 2020; 44:527-532. [DOI: 10.1097/rct.0000000000001032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Elsholtz FHJ, Ro SR, Shnayien S, Erxleben C, Bauknecht HC, Lenk J, Schaafs LA, Hamm B, Niehues SM. Inter- and Intrareader Agreement of NI-RADS in the Interpretation of Surveillance Contrast-Enhanced CT after Treatment of Oral Cavity and Oropharyngeal Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2020; 41:859-865. [PMID: 32327436 DOI: 10.3174/ajnr.a6529] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The Neck Imaging Reporting and Data System was introduced to assess the probability of recurrence in surveillance imaging after treatment of head and neck cancer. This study investigated inter- and intrareader agreement in interpreting contrast-enhanced CT after treatment of oral cavity and oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS This retrospective study analyzed CT datasets of 101 patients. Four radiologists provided the Neck Imaging Reporting and Data System reports for the primary site and neck (cervical lymph nodes). The Kendall's coefficient of concordance (W), Fleiss κ (κF), the Kendall's rank correlation coefficient (τB), and weighted κ statistics (κw) were calculated to assess inter- and intrareader agreement. RESULTS Overall, interreader agreement was strong or moderate for both the primary site (W = 0.74, κF = 0.48) and the neck (W = 0.80, κF = 0.50), depending on the statistics applied. Interreader agreement was higher in patients with proved recurrence at the primary site (W = 0.96 versus 0.56, κF = 0.65 versus 0.30) or in the neck (W = 0.78 versus 0.56, κF = 0.41 versus 0.29). Intrareader agreement was moderate to strong or almost perfect at the primary site (range τB = 0.67-0.82, κw = 0.85-0.96) and strong or almost perfect in the neck (range τB = 0.76-0.86, κw = 0.89-0.95). CONCLUSIONS The Neck Imaging Reporting and Data System used for surveillance contrast-enhanced CT after treatment of oral cavity and oropharyngeal squamous cell carcinoma provides acceptable score reproducibility with limitations in patients with posttherapeutic changes but no cancer recurrence.
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Affiliation(s)
- F H J Elsholtz
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S-R Ro
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S Shnayien
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - C Erxleben
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - H-C Bauknecht
- Institute of Neuroradiology (H.-C.B.), Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - J Lenk
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - L-A Schaafs
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - B Hamm
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S M Niehues
- From the Institute of Radiology (F.H.J.E., S.-R.R., S.S., C.E., J.L., L.-A.S., B.H., S.M.N.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
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22
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Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning. Jpn J Radiol 2020; 38:489-506. [PMID: 32096063 DOI: 10.1007/s11604-020-00929-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Abstract
Extranodal extension (ENE) is a significant prognostic factor in p16-negative head and neck squamous-cell carcinoma and is classified as N3b by the American Joint Committee on Cancer 8th edition. While most previous radiological studies have focused on the diagnostic performance of pathological ENE, radiologists should be able to provide more clinically relevant information on this entity. The purpose of this article is to review the clinical implications of ENE, to describe key imaging features of ENE with clinical and histopathological correlations and to discuss evaluation of ENE for clinical staging, treatment planning, and predicting the response to treatment. First, we discuss the basics of ENE, including definitions of pathological and clinical ENE and its association with imaging findings. Second, we describe the ENE extension pattern at each location according to level system. The crucial structures determining the choice of treatment include the deep fascia in the deep cervical layer, internal and common carotid arteries, and mediastinal structures. Invasion of the muscles, internal jugular vein, nerves, or mandible also affect the surgical procedure. Finally, we discuss assessment of nodal metastasis after chemoradiotherapy.
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23
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Qian DC, Magliocca KR, Aiken AH, Baugnon KL, Brandon DC, Stokes WA, McDonald MW, Patel MR, Baddour HM, Kaka AS, Steuer CE, Saba NF, Shin DM, Beitler JJ. Outcomes and Predictive Value of Post-adjuvant Therapy PET/CT for Locally Advanced Oral Squamous Cell Carcinoma. Laryngoscope 2020; 130:E850-E857. [PMID: 32057110 DOI: 10.1002/lary.28509] [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: 09/20/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS For locally advanced oral squamous cell carcinoma (OSCC) treated by surgery and adjuvant therapy, consensus has yet to be reached on whether the optimal time to initiate surveillance positron emission tomography/computed tomography (PET/CT) scan is before or after adjuvant therapy. In this study, we characterize the utility of PET/CT scans obtained 3 months after adjuvant therapy. STUDY DESIGN PET/CT scans were obtained for 220 patients with stage III, IVA, or IVB OSCC who underwent resection followed by adjuvant radiotherapy or chemoradiotherapy. METHODS Using the Neck Imaging Reporting and Data System, PET/CT scans were dichotomized as suspicious (primary or neck category ≥3, or distant lesion present) versus nonsuspicious. We then computed differences in locoregional progression, distant progression, and overall survival; positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity; and success rate of salvage. RESULTS Sixty-seven patients (30%) had suspicious PET/CT scans, which were significantly associated with local failure (hazard ratio [HR] 14.0, 95% confidence interval [CI] 7.3-26.6), distant failure (HR 18.4, 95% CI 9.6-35.3), and poorer overall survival (HR 9.5, 95% CI 5.0-17.9). Overall PPV, locoregional PPV, NPV, sensitivity, and specificity were 85%, 79%, 73%, 58%, and 92%, respectively. Among those with biopsy-confirmed progression, 37 patients (65%) underwent salvage therapy; four (11%) were without evidence of disease at last follow-up. CONCLUSIONS For locally advanced OSCC, PET/CT scan 3 months after adjuvant therapy is strongly predictive of disease recurrence and survival, demonstrating improved performance over postoperative imaging in previous studies. Following a suspicious post-adjuvant therapy PET/CT scan, cure of locoregional recurrence is possible but unlikely. LEVEL OF EVIDENCE 4 Laryngoscope, 2020.
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Affiliation(s)
- David C Qian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ashley H Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David C Brandon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Mark W McDonald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Harry M Baddour
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Azeem S Kaka
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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24
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Peacock JG, Christensen CT, Banks KP. RESISTing the Need to Quantify: Putting Qualitative FDG-PET/CT Tumor Response Assessment Criteria into Daily Practice. AJNR Am J Neuroradiol 2019; 40:1978-1986. [PMID: 31780460 DOI: 10.3174/ajnr.a6294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
Tumor response assessments are essential to evaluate cancer treatment efficacy and prognosticate survival in patients with cancer. Response criteria have evolved over multiple decades, including many imaging modalities and measurement schema. Advances in FDG-PET/CT have led to tumor response criteria that harness the power of metabolic imaging. Qualitative PET/CT assessment schema are easy to apply clinically, are reproducible, and yield good prognostic results. We present 3 such criteria, namely, the Lugano classification for lymphoma, the Hopkins criteria, and the Neck Imaging Reporting and Data Systems criteria for head and neck cancers. When comparing baseline PET/CTs with interim or end-of-treatment PET/CTs, radiologists can classify the tumor response as complete metabolic response, partial metabolic response, no metabolic response, or progressive disease, which has important implications in directing further cancer management and long-term patient prognosis. The purpose of this article is to review the progression of tumor response assessments from CT- and PET/CT-based quantitative and semi-quantitative systems to PET/CT-based qualitative systems; introduce the classification schema for these systems; and describe how to use these rapid, powerful, and qualitative PET/CT-based systems in daily practice through illustrative cases.
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Affiliation(s)
- J G Peacock
- From the Department of Radiology (J.G.P., K.P.B.), Brooke Army Medical Center, San Antonio, Texas
| | - C T Christensen
- Department of Radiology (C.T.C.), Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - K P Banks
- From the Department of Radiology (J.G.P., K.P.B.), Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology (K.P.B.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
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