Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Department of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2021 Jul;131(7):1535-1541. doi: 10.1002/lary.29366. Epub 2021 Jan 11.
The American Joint Committee on Cancer (AJCC) 8th edition introduced distinct clinical and pathological staging paradigms for human papilloma virus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Treatment planning for OPSCC often utilizes positron emission tomography/computed tomography (PET/CT) to assess clinical stage. We hypothesize that PET/CT will accurately predict final pathologic AJCC 8th edition staging in patients with HPV+ OPSCC.
All patients with primary HPV+ OPSCC with preoperative PET/CT who underwent transoral robotic surgery and neck dissection between 2011 and 2017 were identified. Data were collected via chart review. Two neuroradiologists performed blinded re-evaluation of all scans. Primary tumor size and cervical nodal disease characteristics were recorded and TNM staging was extrapolated. Cohen's kappa statistic was used to assess interrater reliability. Test for symmetry was performed to analyze discordance between radiologic and pathologic staging.
Forty-nine patients met inclusion criteria. Interrater reliability was substantial between radiologists for nodal (N) and overall staging (OS) (κ = 0.715 and 0.715). Radiologist A review resulted in identical OS for 67% of patients, overstaging for 31%, and understaging for 2%. Radiologist B review resulted in 61% identical OS, 39% overstaging, and 0% understaging. In misclassified cases, the test of symmetry shows strong bias toward overstaging N stage and OS (P < .001). Radiologic interpretation of extracapsular extension showed poor interrater reliability (κ = 0.403) and poor accuracy.
PET/CT predicts a higher nodal and overall stage than pathologic staging. PET/CT should not be relied upon for initial tumor staging, as increased FDG uptake is not specific for nodal metastases. PET/CT is shown to be a poor predictor of ECE.
4 Laryngoscope, 131:1535-1541, 2021.
美国癌症联合委员会（AJCC）第 8 版为人乳头瘤病毒（HPV）阳性（HPV+）口咽鳞状细胞癌（OPSCC）引入了独特的临床和病理分期模式。OPSCC 的治疗计划通常利用正电子发射断层扫描/计算机断层扫描（PET/CT）来评估临床分期。我们假设 PET/CT 能够准确预测 HPV+ OPSCC 患者的最终病理 AJCC 第 8 版分期。
所有 2011 年至 2017 年间接受经口机器人手术和颈部淋巴结清扫术的原发性 HPV+ OPSCC 患者，术前均行 PET/CT 检查。通过病历回顾收集数据。两位神经放射科医生对所有扫描进行了盲法重新评估。记录原发肿瘤大小和颈部淋巴结疾病特征，并推断出 TNM 分期。采用 Cohen's kappa 统计量评估两位放射科医生之间的再评估一致性。采用检验对称性分析影像学和病理分期之间的差异。
49 例患者符合纳入标准。放射科医生 A 和 B 之间对淋巴结（N）和总体分期（OS）的再评估具有较强的一致性（κ=0.715 和 0.715）。放射科医生 A 的评估结果与 67%的患者的 OS 完全一致，31%的患者 OS 高估，2%的患者 OS 低估。放射科医生 B 的评估结果与 61%的患者的 OS 完全一致，39%的患者 OS 高估，0%的患者 OS 低估。在分类错误的病例中，检验对称性显示出对 N 期和 OS 高估的强烈偏差（P<0.001）。包膜外扩展的放射学评估显示出较差的再评估一致性（κ=0.403）和准确性。
PET/CT 预测的淋巴结和总体分期高于病理分期。由于 FDG 摄取增加并不特异性地提示淋巴结转移，因此不应依赖 PET/CT 进行初始肿瘤分期。PET/CT 被证明是 ECE 的不良预测因子。
4 级 Laryngoscope, 131:1535-1541, 2021.
