Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu and Berlin Institute of Health Campus Benjamin Franklin, Berlin, Germany.
Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
AJR Am J Roentgenol. 2021 Jul;217(1):198-206. doi: 10.2214/AJR.20.24209. Epub 2020 Sep 2.
Imaging surveillance is important for the early diagnosis of recurrence after definitive treatment of oral squamous cell carcinoma (OSCC). The Neck Imaging Reporting and Data System (NI-RADS) includes a standardized template for surveillance imaging and categorizes probability of recurrence at the primary site and in the neck (cervical lymph nodes) by assigning categories of 1 (no evidence of recurrence), 2 (low suspicion, subdivided into 2a and 2b for the primary site), 3 (high suspicion), and 4 (definite recurrence). The aim of this study was to determine the rate of locoregional and nodal OSCC recurrence stratified by NI-RADS category among patients undergoing surveillance CT or MRI. This retrospective study included 158 patients enrolled in an institutional surveillance program after resection of OSCC with curative intent. A total of 503 contrast-enhanced CT or MRI examinations performed during surveillance were evaluated. Each examination was randomly assigned to one of four radiologists with expertise in head and neck imaging, who provided NI-RADS categories for the primary site and the neck (1006 assigned NI-RADS categories). NI-RADS performance in identifying recurrence was assessed by ROC curve analysis. All four readers evaluated 50 randomly assigned cases to determine interreader agreement by use of the Kendall statistic. Cancer recurrence was confirmed in 7.6% (38/503) of cases for the primary site and in 6.2% (31/503) for the neck. For the primary site, recurrence rates were 1.0% in NI-RADS category 1, 7.1% in category 2a, 5.6% in category 2b, 66.7% in category 3, and 100.0% in category 4. For the neck, recurrence rates were 0.5% in category 1, 7.0% in category 2, 80.0% in category 3, and 100.0% in category 4. NI-RADS had AUC values of 0.934 for the primary site and 0.959 for the neck. Interreader agreement was 0.67 for the primary site and 0.81 for the neck. NI-RADS offers excellent discriminatory power in detection of OSCC recurrence, both for the primary site and the neck. Radiologists and maxillofacial surgeons should implement NI-RADS in surveillance regimens for postoperative OSCC to help detect recurrences in an effective and standardized manner using imaging.
影像学监测对于口腔鳞状细胞癌（OSCC）根治性治疗后复发的早期诊断至关重要。颈淋巴结成像报告和数据系统（NI-RADS）包括一个标准化的监测成像模板，通过将原发部位和颈部（颈部淋巴结）的复发概率分为 1 类（无复发证据）、2 类（低度可疑，原发部位分为 2a 和 2b）、3 类（高度可疑）和 4 类（明确复发）来进行分类。本研究的目的是确定在接受监测 CT 或 MRI 的患者中，根据 NI-RADS 分类，局灶性和区域性 OSCC 复发的发生率。这项回顾性研究纳入了 158 例接受根治性切除 OSCC 后接受机构监测计划的患者。共评估了 503 例增强 CT 或 MRI 监测检查。每次检查均随机分配给 4 位具有头颈部影像学专业知识的放射科医生之一，他们提供原发部位和颈部的 NI-RADS 分类（共分配了 1006 个 NI-RADS 分类）。通过 ROC 曲线分析评估 NI-RADS 对识别复发的性能。所有 4 位读者均评估了 50 例随机分配的病例，以使用 Kendall 统计量评估读者间的一致性。在 503 例病例中，原发部位的癌症复发率为 7.6%（38/503），颈部的癌症复发率为 6.2%（31/503）。对于原发部位，NI-RADS 分类 1 的复发率为 1.0%，分类 2a 为 7.1%，分类 2b 为 5.6%，分类 3 为 66.7%，分类 4 为 100.0%。对于颈部，分类 1 的复发率为 0.5%，分类 2 为 7.0%，分类 3 为 80.0%，分类 4 为 100.0%。NI-RADS 对原发部位和颈部的 AUC 值分别为 0.934 和 0.959。读者间的一致性为原发部位 0.67，颈部 0.81。NI-RADS 对 OSCC 复发的检测具有出色的鉴别能力，无论是原发部位还是颈部。放射科医生和颌面外科医生应在术后 OSCC 的监测方案中实施 NI-RADS，以帮助使用影像学以有效和标准化的方式检测复发。
