Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Eur Radiol. 2023 May;33(5):3693-3703. doi: 10.1007/s00330-023-09407-4. Epub 2023 Jan 31.
Accurate pre-treatment imaging determination of extranodal extension (ENE) could facilitate the selection of appropriate initial therapy for HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Small studies have associated 7 CT features with ENE with varied results and agreement. This article seeks to determine the replicable diagnostic performance of these CT features for ENE.
Five expert academic head/neck neuroradiologists from 5 institutions evaluate a single academic cancer center cohort of 75 consecutive HPV + OPSCC patients. In a web-based virtual laboratory for imaging research and education, the experts performed training on 7 published CT features associated with ENE and then independently identified the "single most (if any) suspicious" lymph node and presence/absence of each of the features. Inter-rater agreement was assessed using percentage agreement, Gwet's AC1, and Fleiss' kappa. Sensitivity, specificity, and positive and negative predictive values were calculated for each CT feature based on histologic ENE.
All 5 raters identified the same node in 52 cases (69%). In 15 cases (20%), at least one rater selected a node and at least one rater did not. In 8 cases (11%), all raters selected a node, but at least one rater selected a different node. Percentage agreement and Gwet's AC1 coefficients were > 0.80 for lesion identification, matted/conglomerated nodes, and central necrosis. Fleiss' kappa was always < 0.6. CT sensitivity for histologically confirmed ENE ranged 0.18-0.94, specificity 0.41-0.88, PPV 0.26-0.36, and NPV 0.78-0.96.
Previously described CT features appear to have poor reproducibility among expert head/neck neuroradiologists and poor predictive value for histologic ENE.
• Previously described CT imaging features appear to have poor reproducibility among expert head and neck subspecialized neuroradiologists as well as poor predictive value for histologic ENE. • Although it may still be appropriate to comment on the presence or absence of these CT features in imaging reports, the evidence indicates that caution is warranted when incorporating these features into clinical decision-making regarding the likelihood of ENE.
准确的术前影像学检查可确定结外侵犯（ENE），有助于为 HPV 阳性口咽鳞癌（HPV+OPSCC）患者选择合适的初始治疗方案。已有小型研究发现 7 项 CT 特征与 ENE 相关，但结果和一致性存在差异。本文旨在确定这些 CT 特征在预测 ENE 方面的可重复性诊断性能。
来自 5 家机构的 5 名医学影像学专家评估了单一学术癌症中心的 75 例连续 HPV+OPSCC 患者。在一个用于医学影像学研究和教育的网络虚拟实验室中，专家们对 7 项与 ENE 相关的已发表 CT 特征进行了培训，然后独立识别出“最可疑（如果有的话）的淋巴结”和每个特征的存在/缺失情况。使用百分比一致性、Gwet's AC1 和 Fleiss' kappa 评估组内一致性。基于组织学上的 ENE，计算每个 CT 特征的敏感性、特异性、阳性预测值和阴性预测值。
在 52 例（69%）中，5 名评估者识别出相同的淋巴结。在 15 例（20%）中，至少有一名评估者选择了淋巴结，而至少有一名评估者未选择。在 8 例（11%）中，所有评估者均选择了淋巴结，但至少有一名评估者选择了不同的淋巴结。在识别病变、磨砂/结块淋巴结和中央坏死方面，百分比一致性和 Gwet's AC1 系数均大于 0.80。Fleiss' kappa 始终小于 0.6。组织学证实的 ENE 的 CT 敏感性为 0.18-0.94，特异性为 0.41-0.88，阳性预测值为 0.26-0.36，阴性预测值为 0.78-0.96。
先前描述的 CT 特征在专家头颈神经放射学家中似乎重复性较差，对组织学上的 ENE 预测价值较低。
先前描述的 CT 成像特征在专家头颈亚专科神经放射学家中似乎重复性较差，对组织学上的 ENE 预测价值较低。
尽管在影像学报告中仍可以对这些 CT 特征的存在或缺失进行描述，但有证据表明，在考虑这些特征对 ENE 可能性的影响并将其纳入临床决策时，应谨慎行事。
