title: Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma.
abstract: BACKGROUND
  Oral cavity squamous cell carcinoma (SCC) represents the most common SCC affecting the head and neck region. Long-term survival of patients with oral cavity SCC is adversely affected by lymph node metastasis and further decreased by the presence of lymph node extracapsular spread (ECS).
  
  
  METHODS
  Using a case-control design, preoperative CT scans from patients with oral cavity SCC and metastatic lymphadenopathy were evaluated by 2 independent neuroradiologists, blinded to the study, for a number of radiologic parameters, including central node necrosis. Multivariate logistic regression was used to identify parameters independently predicting pathologic ECS.
  
  
  RESULTS
  For both neuroradiologists, central node necrosis was a significant predictor of ECS, with high interrater agreement (kappa = 0.71). On multivariate analysis, only central node necrosis independently predicted ECS (odds ratio [OR] = 12.1; 95% confidence interval [CI] = 1.24-119). Central node necrosis predicted ECS with 91% sensitivity and 88% negative predictive values.
  
  
  CONCLUSIONS
  Our findings suggest that central node necrosis on preoperative CT scans is strongly associated with the presence of ECS.
authors: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors: Derrick R
authors: DR
authors: Randall
authors: John T
authors: JT
authors: Lysack
authors: Marc E
authors: ME
authors: Hudon
authors: Kelly
authors: K
authors: Guggisberg
authors: Steven C
authors: SC
authors: Nakoneshny
authors: T
authors: T
authors: Wayne Matthews
authors: Joseph C
authors: JC
authors: Dort
authors: Shamir P
authors: SP
authors: Chandarana
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000601:surgery; D009333:Neck; D037981:Neck Dissection; D009336:Necrosis / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: CT; extracapsular spread; head and neck; oral cavity; squamous cell carcinoma