title: The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  The aim of this study was to validate the role of diffusion-weighted imaging (DWI) at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se) and specificity (Spe) of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference.
  
  
  RESULTS
  In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC) value was 0.903 × 10(-3) mm(2)/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10(-3) mm(2)/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC) of 0.964, while morphological criteria displayed an AUC of 0.715.
  
  
  CONCLUSIONS
  In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection.
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00186 Rome, Italy.
authors.forename: Flavio
authors.identifier: 0000-0001-6291-7904
authors.initials: F
authors.lastname: Barchetti
authors.affiliation: Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, 00186 Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Pranno
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.
authors.forename: Guglielmo
authors.identifier: 0000-0001-8307-6921
authors.initials: G
authors.lastname: Giraldi
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00186 Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sartori
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00186 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gigli
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00186 Rome, Italy.
authors.forename: Giovanni
authors.identifier: 0000-0003-2837-7240
authors.initials: G
authors.lastname: Barchetti
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00186 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Lo Mele
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy.
authors.forename: Luigi Tonino
authors.initials: LT
authors.lastname: Marsella
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology*; D002574:Cervical Vertebrae / Q000473:pathology*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D000077195:Squamous Cell Carcinoma of Head and Neck