Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma

Laryngoscope. 2015 Jul;125(7):1613-8. doi: 10.1002/lary.25140. Epub 2015 May 6.


Objective: To determine the accuracy of pretreatment, contrast-enhanced computed tomography (CT) in the diagnosis of extracapsular spread (ECS) in cervical lymph node metastases from p16-positive head-and-neck squamous cell carcinoma (HNSCC).

Study design: Retrospective observational study.

Methods: Sixty-five (n = 65) patients diagnosed between 2004 and 2013 with p16-positive HNSCC and with cervical lymph node metastases measuring at least 1 centimeter in diameter on pathological assessment were included. All patients underwent primary surgical treatment. Subjects' preoperative contrast-enhanced neck CT scans were independently assigned a score for the likelihood of ECS (5-point scale) by two board-certified neuroradiologists. Receiver-operating characteristic curves were generated, and optimal sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each radiologist.

Results: On histological analysis, the majority of patients (58%; 38/65) were found to have ECS, and 29% (19/65) of patients had ≥ three metastatic lymph nodes. For radiologist 1, PPV and NPV for ECS detection were 72% (95% confidence interval (CI), 53%-87%) and 53% (95% CI, 36%-70%), respectively. For radiologist 2, PPV and NPV for ECS detection were 82% (95% CI, 60 %-95%) and 53% (95% CI, 38%-69%), respectively.

Conclusion: CT is not a reliable method for determining the presence of ECS in p16-positive HNSCC patients.

Keywords: Extracapsular spread; HPV; computed tomography; p16.

Publication types

  • Observational Study

MeSH terms

  • Biomarkers, Tumor / metabolism
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / metabolism
  • Carcinoma, Squamous Cell / secondary
  • Female
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / metabolism
  • Head and Neck Neoplasms / secondary
  • Humans
  • Immunohistochemistry
  • Lymph Nodes / diagnostic imaging*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neck
  • Neoplasm Staging
  • ROC Curve
  • Reproducibility of Results
  • Retrospective Studies
  • Squamous Cell Carcinoma of Head and Neck
  • Tomography, X-Ray Computed / methods*
  • Viral Core Proteins / metabolism*


  • 16 kDa protein, hepatitis C virus
  • Biomarkers, Tumor
  • Viral Core Proteins