计算机断层扫描预测头颈部癌症患者初始手术切除后病理性淋巴结包膜外侵犯的准确性。
Accuracy of computed tomography for predicting pathologic nodal extracapsular extension in patients with head-and-neck cancer undergoing initial surgical resection.
机构信息
Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
Department of Pathology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Jan 1;88(1):122-9. doi: 10.1016/j.ijrobp.2013.10.002.
PURPOSE
Nodal extracapsular extension (ECE) in patients with head-and-neck cancer increases the loco-regional failure risk and is an indication for adjuvant chemoradiation therapy (CRT). To reduce the risk of requiring trimodality therapy, patients with head-and-neck cancer who are surgical candidates are often treated with definitive CRT when preoperative computed tomographic imaging suggests radiographic ECE. The purpose of this study was to assess the accuracy of preoperative CT imaging for predicting pathologic nodal ECE (pECE).
METHODS AND MATERIALS
The study population consisted of 432 consecutive patients with oral cavity or locally advanced/nonfunctional laryngeal cancer who underwent preoperative CT imaging before initial surgical resection and neck dissection. Specimens with pECE had the extent of ECE graded on a scale from 1 to 4.
RESULTS
Radiographic ECE was documented in 46 patients (10.6%), and pECE was observed in 87 (20.1%). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 43.7%, 97.7%, 82.6%, and 87.3%, respectively. The sensitivity of radiographic ECE increased from 18.8% for grade 1 to 2 ECE, to 52.9% for grade 3, and 72.2% for grade 4. Radiographic ECE criteria of adjacent structure invasion was a better predictor than irregular borders/fat stranding for pECE.
CONCLUSIONS
Radiographic ECE has poor sensitivity, but excellent specificity for pECE in patients who undergo initial surgical resection. PPV and NPV are reasonable for clinical decision making. The performance of preoperative CT imaging increased as pECE grade increased. Patients with resectable head-and-neck cancer with radiographic ECE based on adjacent structure invasion are at high risk for high-grade pECE requiring adjuvant CRT when treated with initial surgery; definitive CRT as an alternative should be considered where appropriate.
目的
头颈部癌症患者的淋巴结包膜外扩展（ECE）会增加局部区域失败的风险，是辅助放化疗（CRT）的指征。为了降低需要三联疗法的风险，对于术前计算机断层扫描（CT）影像学提示存在放射性 ECE 的头颈部癌症手术候选患者，常采用根治性 CRT 进行治疗。本研究旨在评估术前 CT 成像预测病理性淋巴结 ECE（pECE）的准确性。
方法和材料
研究人群包括 432 例连续接受初始手术切除和颈部清扫术前 CT 成像的口腔或局部晚期/无功能喉癌患者。pECE 标本的 ECE 程度按 1 至 4 级进行分级。
结果
46 例（10.6%）患者存在影像学 ECE，87 例（20.1%）患者存在 pECE。影像学 ECE 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 43.7%、97.7%、82.6%和 87.3%。影像学 ECE 分级为 1 级和 2 级时的敏感性为 18.8%，而 3 级和 4 级时的敏感性分别为 52.9%和 72.2%。与不规则边界/脂肪条纹相比，相邻结构侵犯的影像学 ECE 标准是预测 pECE 的更好指标。
结论
对于接受初始手术切除的患者，影像学 ECE 对 pECE 的敏感性较差，但特异性较好。PPV 和 NPV 可用于临床决策。随着 pECE 分级的增加，术前 CT 成像的性能有所提高。对于影像学上有 ECE 且基于相邻结构侵犯的可切除头颈部癌症患者，若采用初始手术治疗，其发生需要辅助 CRT 的高级别 pECE 的风险较高；在适当的情况下，应考虑采用根治性 CRT 作为替代方案。
Zotero 插件