Diagnostic ability of contrast-enhanced computed tomography for metastatic cervical nodes in head and neck squamous cell carcinomas: significance of additional coronal reconstruction images
More details
Hide details
Gifu University School of Medicine, Japan
Submission date: 2019-06-17
Acceptance date: 2019-11-26
Publication date: 2020-01-06
Pol J Radiol, 2020; 85: 1-7
To evaluate the significance of additional coronal reconstruction images in the diagnostic ability of contrast- enhanced computed tomography (CECT) for metastatic cervical nodes in patients with head and neck squamous cell carcinomas (HNSCC).

Material and methods:
We retrospectively assessed 97 metastatic and 141 reactive histologically proven cervical nodes of 38 patients with HNSCC, who underwent CECT before neck dissection. Observer #1, an expert radiologist in head and neck imaging, and observer #2, a general radiologist, reviewed all CECT images. The observers first assessed the presence of nodal metastasis using axial CECT alone (A-CECT). Three days later, they reassessed its presence using combined axial and coronal CECT (A&C-CECT).

The sensitivity of A-CECT vs. A&C-CECT was 73.2% vs. 75.3% for observer #1 (p = 0.73) and 69.1% vs. 69.1% for observer #2 (p = 1.00), respectively. The specificity of A-CECT versus A&C-CECT was 92.2% vs. 97.2% for observer #1 (p < 0.05) and 92.9% vs. 95.7% for observer #2 (p = 0.22), respectively. The accuracy of A-CECT versus A&C-CECT was 84.5% vs. 88.2% for observer #1 (p < 0.05) and 83.2% vs. 85.3% for observer #2 (p = 0.30), respectively. The area under the curve (AUC) of A-CECT vs. A&C-CECT was 0.86 vs. 0.91 for observer #1 (p < 0.05) and 0.85 vs. 0.85 for observer #2 (p = 0.80), respectively.

The specificity, accuracy, and AUC increased with the use of coronal images during the assessment by the expert radiologist. The appropriate use of coronal images allowed proper configuration recognition and improved diagnostic ability.

Leemans CR, Tiwari R, Nauta JJ, et al. Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor. Cancer 1994; 73: 187-190.
Clark J, Li W, Smith G, et al. Outcome of treatment for advanced cervical metastatic squamous cell carcinoma. Head Neck 2005; 27: 87-94.
Jan JC, Hsu WH, Liu SA, et al. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg 2011; 69: 396-404.
Kokemueller H, Rana M, Rublack J, et al. The Hannover experience: surgical treatment of tongue cancer – a clinical retrospective evaluation over a 30 years period. Head Neck Oncol 2011; 3: 27.
Scherpelz KP, Wong AC, Lingen MW, et al. Histological features and prognostic significance of treatment effect in lymph node metastasis in head and neck squamous cell carcinoma. Histopathology 2019; 74: 321-331.
Chu HR, Kim JH, Yoon DY, et al. Additional diagnostic value of (18)F-FDG PET-CT in detecting retropharyngeal nodal metastases. Otolaryngol Head Neck Surg 2009; 141: 633-638.
Kato H, Kanematsu M, Watanabe H, et al. Metastatic retropharyngeal lymph nodes: comparison of CT and MR imaging for diagnostic accuracy. Eur J Radiol 2014; 83: 1157-1162.
van den Brekel MW, Stel HV, Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 1990; 177: 379-384.
Curtin HD, Ishwaran H, Mancuso AA, et al. Comparison of CT and MR imaging in staging of neck metastases. Radiology 1998; 207: 123-130.
Sakai O, Curtin HD, Romo LV, et al. Lymph node pathology. Benign proliferative, lymphoma, and metastatic disease. Radiol Clin North Am 2000; 38: 979-998.
Liu Z, Zeng W, Liu C, et al. Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study. World J Surg Oncol 2017; 15: 32.
Wu LM, Xu JR, Liu MJ, et al. Value of magnetic resonance imaging for nodal staging in patients with head and neck squamous cell carcinoma: a meta-analysis. Acad Radiol 2012; 19: 331-340.
Sun R, Tang X, Yang Y, et al. (18)FDG-PET/CT for the detection of regional nodal metastasis in patients with head and neck cancer: a meta-analysis. Oral Oncol 2015; 51: 314-320.
Bartlett ES, Walters TD, Yu E. Can axial-based nodal size criteria be used in other imaging planes to accurately determine “enlarged” head and neck lymph nodes? ISRN Otolaryngol 2013; 2013: 232968.
Chen C, Zhang M, Xu Y, et al. Unidimensional measurement may evaluate target lymph nodal response after induction chemotherapy for nasopharyngeal carcinoma. Medicine (Baltimore) 2016; 95: e2667.
Schreyer AG, Scheibl K, Zorger N, et al. Detection rate and efficiency of lymph node assessment with axial and coronal image reading based on 16 row multislice CT of the neck. Rofo 2005; 177: 1430-1435.
Som PM, Curtin HD, Mancuso AA. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol 2000; 174: 837-844.
Steinkamp HJ, Hosten N, Richter C, et al. Enlarged cervical lymph nodes at helical CT. Radiology 1994; 191: 795-798.
Vj R, A SA, Mufeed A, et al. Characterization of cervicofacial lymphnodes – a clinical and ultrasonographic study. J Clin Diagn Res 2014; 8: ZC25-28.
Elson M, Rothman M, Ord RA. False-positive computed tomography scan mimicking metastasis due to fatty hilum in a cervical lymph node. J Oral Maxillofac Surg 1994; 52: 1334-1336.
Vassallo P, Edel G, Roos N, et al. In-vitro high-resolution ultrasonography of benign and malignant lymph nodes. A sonographic-pathologic correlation. Invest Radiol 1993; 28: 698-705.
Journals System - logo
Scroll to top