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Lymph node central necrosis on computed tomography as predictor of extracapsular spread in metastatic head and neck squamous cell carcinoma: pilot study

Published online by Cambridge University Press:  24 June 2010

R A Zoumalan ,
A J Kleinberger ,
L G T Morris ,
A Ranade ,
H Yee ,
M D DeLacure  and
D Myssiorek
R A Zoumalan*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, USA.
A J Kleinberger
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, USA.
L G T Morris
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, USA.
A Ranade
Affiliation:
Department of Pathology, New York University School of Medicine, New York, USA.
H Yee
Affiliation:
Department of Pathology, New York University School of Medicine, New York, USA.
M D DeLacure
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, USA.
D Myssiorek
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, USA.
*
Address for correspondence: Dr R A Zoumalan, 430 1st Ave, NBV 5E5, New York, NY 10016, USA. Fax: +1 212 434 4222 E-mail: Richard.zoumalan@nyumc.org
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Abstract

Objective:

This study aimed (1) to investigate the relationship between the presence of lymph node central necrosis, viewed on pre-operative computed tomography imaging, and the occurrence of histopathologically determined metastatic lymph node extracapsular spread and (2) to determine whether a larger scale study would be valuable.

Materials and methods:

Pre-operative computed tomography scans, surgical records and post-operative histopathological analysis results were reviewed for 19 consecutive neck dissections performed in 17 patients with head and neck squamous cell carcinoma.

Results:

A total of 20/26 (77 per cent) lymph nodes with central necrosis had extracapsular spread on histopathological analysis. Twenty of 21 (95 per cent) lymph nodes with extracapsular spread had central necrosis on pre-operative computed tomography. Thirty-four of 40 (85 per cent) lymph nodes without extracapsular spread had no evidence of central necrosis on computed tomography. Only three of 12 (25 per cent) patients with lymph node central necrosis identified on pre-operative computed tomography were found to have actual necrosis on final histopathological analysis.

Conclusions:

Lymph node central necrosis viewed on pre-operative computed tomography scans is a useful indicator of metastatic lymph node extracapsular spread, with a sensitivity of 95 per cent, a specificity of 85 per cent, a positive predictive value of 69 per cent and a negative predictive value of 98 per cent. Lymph node diameter is not a sensitive indicator of extracapsular spread.

Keywords

Lymph NodeCervicalCentralNecrosisExtensionSquamous Cell CarcinomaMetastasisComputerized Tomography ScanComputerized Axial Tomography Scan
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 12 , December 2010 , pp. 1284 - 1288
Copyright
Copyright © JLO (1984) Limited 2010

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Footnotes

Presented as a poster at the American Head and Neck Society 7th International Conference on Head and Neck Cancer, 20 September 2008, San Francisco, California, USA.

References

1Johnson, JT, Myers, EN, Bedetti, CD, Barnes, EL, Schramm, VL, Thearle, PB. Cervical lymph node metastases: incidence and implications of extracapsular carcinoma. Arch Otolaryngol 1985;111:534–7Google Scholar
2Snyderman, NL, Johnson, JT, Schramm, VL, Myers, EN, Bedetti, CD, Thearle, P. Extracapsular spread of carcinoma in cervical lymph nodes: impact upon survival in patients with carcinoma of the supraglottic larynx. Cancer 1985;56:1597–9Google Scholar
3Carvalho, BM. Quantitative analysis of the extent of extracapsular invasion and its prognostic significance: a prospective study of 170 cases of carcinoma of the larynx and hypopharynx. Head Neck 1998;20:16–213.0.CO;2-6>CrossRefGoogle Scholar
4Cooper, JS, Pajak, TF, Forastiere, AA, Jacobs, J, Campbell, BH, Saxman, SB et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl Med J 2004;350:1937–44CrossRefGoogle ScholarPubMed
5Som, PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol 1992;158:961–9CrossRefGoogle Scholar
6Van den Brekel, MW, Stel, HV, Castelijins, JA, Nauta, JJ, van der Waal, I, Valk, J, et al. Cervical lymph node metastases: assessment of radiological criteria. Radiology 1990;177:379–84Google Scholar
7Steinkamp, HJ, van der Hoeck, E, Böck, JC, Felix, R. The extracapsular spread of cervical lymph node metastases: the diagnostic value of computed tomography [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1999;170:457–62CrossRefGoogle ScholarPubMed
8Van den Brekel, MW, van der Waal, I, Meijer, CJ, Freeman, JL, Castelijns, JA, Snow, B. The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections. Laryngoscope 1996;106:987–91Google Scholar
9Yousem, DM, Som, PM, Hackney, DB, Schwaibold, F, Hendrix, RA. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT. Radiology 1992;182:753–9CrossRefGoogle ScholarPubMed
10Steinkamp, HJ, Hosten, N, Richter, C, Schedel, H, Felix, R. Enlarged cervical lymph nodes at helical CT. Radiology 1994;191:795–8CrossRefGoogle ScholarPubMed
11Tartaglione, T, Summaria, V, Medoro, A, Brunetti, D, Di Lella, GM, Zacchei, P. Metastatic lymphadenopathy from ENT carcinoma: role of diagnostic imaging. Rays 2000;25:429–46Google ScholarPubMed
12Don, DM, Anzai, Y, Lufkin, RB, Fu, YS, Calcaterra, TC. Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 1995;105:669–74CrossRefGoogle ScholarPubMed
13Johnson, JT, Barnes, EL, Myers, EN, Schramm, VL Jr, Borochovitz, D, Sigler, BA. The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol 1981;107:725–9CrossRefGoogle ScholarPubMed
14Hirabayashi, H, Koshii, K, Uno, K, Ohgaki, H, Nakasone, Y, Fujisawa, T et al. Extracapsular spread of squamous cell carcinoma in neck lymph nodes: prognostic factor of laryngeal cancer. Laryngoscope 1991;101:502–6Google Scholar
15Grandi, C, Alloisio, M, Moglia, D, Podrecca, S, Sala, L, Salvatori, P et al. Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications. Head Neck Surg 1985;8:67–73CrossRefGoogle ScholarPubMed
16Carter, RL, Bliss, JM, Soo, K, O'Brien, CJ. Radical neck dissection for squamous carcinomas: pathological findings and their clinical implications with particular reference to transcapsular spread. Int J Radiat Oncol Biol Phys 1987;13:825–32Google Scholar
17Giancarlo, T, Palmieri, A, Giacomarra, V, Russolo, M. Pre-operative evaluation of cervical adenopathies in tumours of the upper aerodigestive tract. Anticancer Res 1998;18:2805–9Google ScholarPubMed
18Jose, J, Coatesworth, AP, Johnston, C, MacLennan, K. Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract: the significance of extracapsular spread and soft tissue deposits. Head Neck 2003;25:451–6CrossRefGoogle ScholarPubMed
19Alvi, A, Johnson, JT. Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 1996;114:65–70CrossRefGoogle ScholarPubMed