Mose Lucas, Korkmaz Emre, Visini Miranda, Giger Roland, Schanne Daniel Hendrik, Elicin Olgun
Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Strahlenther Onkol. 2025 Sep 2. doi: 10.1007/s00066-025-02460-6.
There is no uniformity across various guidelines in defining the modality and frequency of the follow-up, particularly regarding radiological imaging. The objective is to assess the diagnostic performance of magnetic resonance imaging (MRI)-based posttreatment surveillance for early-stage (I-II) glottic squamous cell carcinoma of the larynx.
The follow-up of patients diagnosed with glottic squamous cell carcinoma of the larynx, treated with radiotherapy or surgery in curative intent, was analyzed over a period of 2 years posttreatment. MRI diagnostic performance metrics were calculated using clinical and post-MRI endoscopic examinations as the reference standard. MRI sequences included both anatomical and functional imaging, including diffusion-weighted imaging.
In total, 171 eligible MRIs were analyzed in the follow-up. Recurrences were identified with a sensitivity of 75% and a specificity of 99%. However, the positive predictive value of MRI surveillance reflects considerable uncertainty in the diagnosis of recurrences based solely on MRI findings, dropping as low as 21% in sensitivity analyses. Moreover, a notable proportion of MRIs were inconclusive.
MRI demonstrates high specificity and acceptable sensitivity; however, the limited positive predictive value raises concerns regarding its utility as a stand-alone surveillance tool.
在定义随访的方式和频率方面，尤其是在放射影像学方面，各种指南之间缺乏一致性。目的是评估基于磁共振成像（MRI）的治疗后监测对早期（I-II期）喉声门鳞状细胞癌的诊断性能。
对诊断为喉声门鳞状细胞癌且接受了根治性放疗或手术的患者进行了治疗后2年的随访分析。以临床和MRI后内镜检查作为参考标准，计算MRI的诊断性能指标。MRI序列包括解剖成像和功能成像，包括弥散加权成像。
随访中总共分析了171例符合条件的MRI。识别复发的敏感性为75%，特异性为99%。然而，MRI监测的阳性预测值反映出仅基于MRI结果诊断复发存在相当大的不确定性，在敏感性分析中低至21%。此外，相当一部分MRI结果不明确。
MRI显示出高特异性和可接受的敏感性；然而，有限的阳性预测值引发了对其作为独立监测工具效用的担忧。
