Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma

J Med Imaging Radiat Oncol. 2019 Aug;63(4):500-509. doi: 10.1111/1754-9485.12888. Epub 2019 Apr 11.


Background: Extracapsular spread (ECS) of lymph node metastases is associated with poor prognosis and is an indication for adjuvant chemoradiotherapy. Accurately identifying ECS using imaging may allow us to recommend primary chemoradiotherapy to avoid trimodality treatment. We investigated the accuracy of staging CT in diagnosing ECS in P16 + oropharyngeal squamous cell carcinoma (OPSCC).

Methods: Patients with pathologically determined cervical nodal metastases from P16 + OPSCC were included. Two blinded radiologists scored images to predict the presence of ECS in comparison to histopathology.

Results: Eighty patients with a total of 91 specimens were evaluated. Pathologic ECS was identified in 53.8% of the patients. Sensitivity and specificity of CT for the two observers were 56.5% and 60.9%, and 73.3% and 66.7%, respectively. The presence of perinodal stranding was found to be significantly associated with pathological ECS.

Conclusion: Computed tomography displays consistently high specificity, which may be used to rule out the presence of extracapsular spread in cervical nodal metastases of P16 + oropharyngeal squamous cell carcinoma.

Keywords: computed tomography; extracapsular spread; extranodal extension; human papillomavirus; oropharynx; squamous cell carcinoma.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / pathology
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymphatic Metastasis / diagnostic imaging*
  • Male
  • Middle Aged
  • Neck
  • Oropharyngeal Neoplasms / diagnostic imaging*
  • Oropharyngeal Neoplasms / pathology
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Squamous Cell Carcinoma of Head and Neck / diagnostic imaging*
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Tomography, X-Ray Computed / methods*