Neck Imaging Reporting and Data System Category 3 on Surveillance Computed Tomography: Incidence, Biopsy Rate, and Predictive Performance in Head and Neck Squamous Cell Carcinoma

Erik D Johansson; Ryan T Hughes; Nuwan T Meegalla; Mercedes Porosnicu; Hafiz S Patwa; Christopher M Lack; Paul M Bunch

doi:10.1002/lary.30025

Neck Imaging Reporting and Data System Category 3 on Surveillance Computed Tomography: Incidence, Biopsy Rate, and Predictive Performance in Head and Neck Squamous Cell Carcinoma

Laryngoscope. 2022 Sep;132(9):1792-1797. doi: 10.1002/lary.30025. Epub 2022 Jan 19.

Authors

Erik D Johansson¹, Ryan T Hughes², Nuwan T Meegalla³, Mercedes Porosnicu⁴, Hafiz S Patwa³, Christopher M Lack⁵, Paul M Bunch⁶

Affiliations

¹ Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
² Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
³ Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
⁴ Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
⁵ Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
⁶ Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, U.S.A.

PMID: 35043989
DOI: 10.1002/lary.30025

Abstract

Objectives: Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system for head and neck cancer surveillance. Imaging findings of high suspicion for recurrence are assigned Category 3 and recommended for "Biopsy, if clinically indicated." After implementing NI-RADS for surveillance neck computed tomography (CT), our objectives are to determine the incidence of squamous cell carcinoma (SCC) Category 3 lesions in the year post-implementation, the associated biopsy rate, and the positive predictive value of NI-RADS 3 for SCC recurrence.

Study design: Retrospective cohort study.

Methods: Neck CTs reported with NI-RADS between February 2020 and February 2021 were reviewed to identify patients undergoing surveillance for SCC assigned NI-RADS 3. Cancer recurrence, defined as positive biopsy result or treatment of clinically determined recurrence, was determined by electronic medical record review.

Results: During the study period, 580 neck CTs were reported with NI-RADS, of which 39 (7%) CTs obtained in 37 unique patients (28 male, 9 female, mean age 66.6 years) formed the study cohort. Biopsies were obtained in 23 lesions (45%), of which 17 (74%) were positive for recurrent SCC. One nondiagnostic biopsy was clinically determined to represent recurrence. Of 28 (55%) lesions not biopsied, 18 (64%) were ultimately treated as clinically determined recurrence. Thus, among 51 individual NI-RADS 3 lesions (32 primary, 19 neck), 36 (71%) represented recurrence.

Conclusion: The incidence of NI-RADS 3 lesions in our cohort was 7%. The biopsy rate was 45%, and the overall positive predictive value of NI-RADS 3 for recurrent SCC was 71%. Category 3 lesions are associated with substantial SCC recurrence risk and should be managed accordingly.

Level of evidence: 4 Laryngoscope, 132:1792-1797, 2022.

Keywords: Head and neck cancer; Neck Imaging Reporting and Data System; neck computed tomography; squamous cell carcinoma; surveillance imaging.

MeSH terms

Aged
Biopsy
Carcinoma, Squamous Cell* / diagnostic imaging
Carcinoma, Squamous Cell* / epidemiology
Female
Head and Neck Neoplasms* / diagnostic imaging
Head and Neck Neoplasms* / epidemiology
Humans
Incidence
Male
Neoplasm Recurrence, Local / diagnostic imaging
Neoplasm Recurrence, Local / epidemiology
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck / diagnostic imaging
Squamous Cell Carcinoma of Head and Neck / epidemiology
Tomography, X-Ray Computed / methods