title: Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma.
abstract: OBJECTIVE
  To determine the accuracy of pretreatment, contrast-enhanced computed tomography (CT) in the diagnosis of extracapsular spread (ECS) in cervical lymph node metastases from p16-positive head-and-neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Sixty-five (n = 65) patients diagnosed between 2004 and 2013 with p16-positive HNSCC and with cervical lymph node metastases measuring at least 1 centimeter in diameter on pathological assessment were included. All patients underwent primary surgical treatment. Subjects' preoperative contrast-enhanced neck CT scans were independently assigned a score for the likelihood of ECS (5-point scale) by two board-certified neuroradiologists. Receiver-operating characteristic curves were generated, and optimal sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each radiologist.
  
  
  RESULTS
  On histological analysis, the majority of patients (58%; 38/65) were found to have ECS, and 29% (19/65) of patients had ≥ three metastatic lymph nodes. For radiologist 1, PPV and NPV for ECS detection were 72% (95% confidence interval (CI), 53%-87%) and 53% (95% CI, 36%-70%), respectively. For radiologist 2, PPV and NPV for ECS detection were 82% (95% CI, 60 %-95%) and 53% (95% CI, 38%-69%), respectively.
  
  
  CONCLUSIONS
  CT is not a reliable method for determining the presence of ECS in p16-positive HNSCC patients.
authors.affiliation: Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Maxwell
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Tanya J
authors.initials: TJ
authors.lastname: Rath
authors.affiliation: Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: James K
authors.initials: JK
authors.lastname: Byrd
authors.affiliation: Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: William G
authors.initials: WG
authors.lastname: Albergotti
authors.affiliation: University of Pittsburgh Cancer Institute, Biostatistics Facility, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Seungwon
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: Barton F
authors.initials: BF
authors.lastname: Branstetter
authors.affiliation: Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014758:Viral Core Proteins / Q000378:metabolism*
chemical_list: C085973:16 kDa protein, hepatitis C virus; D014408:Biomarkers, Tumor; D014758:Viral Core Proteins
keywords: Extracapsular spread; HPV; computed tomography; p16