计算机断层扫描在预测 HPV 阳性口咽癌结外侵犯中的性能。
Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer.
机构信息
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, U.S.A.
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.
出版信息
Laryngoscope. 2020 Jun;130(6):1479-1486. doi: 10.1002/lary.28237. Epub 2019 Aug 14.
OBJECTIVES
To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC).
STUDY DESIGN
Retrospective study.
METHODS
Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologist-specific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature.
RESULTS
Thirty-two (44%) patients had ENE-positive lymph nodes. The presence of irregular margins (OR = 12.3, 95% confidence interval [CI] = 2.3-65.9; OR = 7.0, 95% CI = 1.4-36.3) and absence of perinodal fat plane (OR = 6.8, 95% CI = 2.0-23.3; OR = 14.2, 95% CI = 1.7-120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (Sn = 45%, Sp = 94%, AUC = 69%, PPV = 82%, NPV = 73%; Sn = 28%, Sp = 95%, AUC = 61%, PPV = 80%, NPV = 64%). Absence of perinodal fat plane was most sensitive for ENE (Sn = 87%, Sp = 50%, AUC = 69%, PPV = 59%, NPV = 62%; Sn = 96%, Sp = 34%, AUC = 65%, PPV = 53%, NPV = 63%).
CONCLUSIONS
Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively.
LEVEL OF EVIDENCE
4 Laryngoscope, 130:1479-1486, 2020.
目的
评估七种预设成像特征在 HPV 阳性口咽癌（HPV-OPC）颈淋巴结转移患者的术前 CT（cCT）中的表现特征，以识别淋巴结外侵犯（ENE）。
研究设计
回顾性研究。
方法
纳入 73 例接受原发手术和颈淋巴结清扫术的 HPV-OPC 患者。两名放射科医生对术前增强 CT（cCT）图像进行评估，结果不了解病理结果。对每个 cCT 进行了七个感兴趣的成像特征评分：1）包膜轮廓不清晰，2）淋巴结边缘不规则，3）周围脂肪纹理，4）周围脂肪平面，5）淋巴结坏死，6）淋巴结内囊肿，7）淋巴结融合。采用 logistic 回归确定每个成像特征的放射科医生特异性比值比（OR），以及每个成像特征的放射科医生特异性接收者操作特征（敏感性 [Sn]、特异性 [Sp]、曲线下面积 [AUC]、阳性预测值 [PPV]、阴性预测值 [NPV]）。
结果
32 例（44%）患者的淋巴结存在 ENE 阳性。不规则边缘的存在（OR=12.3，95%置信区间 [CI] = 2.3-65.9；OR=7.0，95% CI = 1.4-36.3）和周围脂肪平面的缺失（OR=6.8，95% CI = 2.0-23.3；OR=14.2，95% CI = 1.7-120.5）与每位放射科医生的 ENE 显著相关。不规则的淋巴结边缘状态对 ENE 最具特异性（Sn=45%，Sp=94%，AUC=69%，PPV=82%，NPV=73%；Sn=28%，Sp=95%，AUC=61%，PPV=80%，NPV=64%）。缺乏周围脂肪平面对 ENE 最敏感（Sn=87%，Sp=50%，AUC=69%，PPV=59%，NPV=62%；Sn=96%，Sp=34%，AUC=65%，PPV=53%，NPV=63%）。
结论
在假设与 ENE 状态相关的七种成像特征中，不规则的淋巴结边缘和缺乏周围脂肪平面分别是最具特异性和敏感性的特征。
证据水平
4 级喉镜，130：1479-1486，2020。
Zotero 插件