title: Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma.
abstract: OBJECTIVE
  The increasing impact of diagnosing extracapsular spread by using imaging, especially in patients with oropharyngeal squamous cell carcinoma, highlights the need to rigorously evaluate the diagnostic accuracy of imaging. Previous analysis suggested 62.5%-80.9% sensitivity and 60%-72.7% specificity. Our goals were to evaluate the accuracy of imaging in diagnosing extracapsular spread in a cohort of patients with oral cavity squamous cell carcinoma (pathologic confirmation of extracapsular spread routinely available), as a proxy for oropharyngeal squamous cell carcinoma, and to independently assess the reliability of imaging features (radiographic lymph node necrosis, irregular borders/stranding, gross invasion, and/or node size) in predicting pathologically proven extracapsular spread.
  
  
  METHODS
  One hundred eleven consecutive patients with untreated oral cavity squamous cell carcinoma and available preoperative imaging and subsequent lymph node dissection were studied. Two neuroradiologists blinded to pathologically proven extracapsular spread status and previous radiology reports independently reviewed all images to evaluate the largest suspicious lymph node along the expected drainage pathway. Radiologic results were correlated with pathologic results from the neck dissections.
  
  
  RESULTS
  Of 111 patients, 29 had radiographically determined extracapsular spread. Pathologic examination revealed that 28 of 111 (25%) had pathologically proven extracapsular spread. Imaging sensitivity and specificity for extracapsular spread were 68% and 88%, respectively. Radiographs were positive for lymph node necrosis in 84% of the patients in the pathology-proven extracapsular spread group and negative in only 7% of those in the pathologically proven extracapsular spread-negative group. On logistic regression analysis, necrosis (P = .001), irregular borders (P = .055), and gross invasion (P = .068) were independently correlated with pathologically proven extracapsular spread.
  
  
  CONCLUSIONS
  Although the specificity of cross-sectional imaging for extracapsular spread was high, the sensitivity was low. Combined logistic regression analysis found that the presence of necrosis was the best radiologic predictor of pathologically proven extracapsular spread, and irregular borders and gross invasion were nearly independently significant.
authors.affiliation: From the Departments of Radiology and Imaging Sciences (J.J.B., A.H.A., A.S.C., K.L.B., P.A.H.) ashley.aiken@emoryhealthcare.org.
authors.forename: A H
authors.initials: AH
authors.lastname: Aiken
authors.affiliation: Emory University School of Medicine (S.P.), Atlanta, Georgia.
authors.forename: S
authors.initials: S
authors.lastname: Poliashenko
authors.affiliation: From the Departments of Radiology and Imaging Sciences (J.J.B., A.H.A., A.S.C., K.L.B., P.A.H.) Otolaryngology Head and Neck Surgery (A.Y.C., J.J.B.) Radiation Oncology (J.J.B.), Hematology and Medical Oncology.
authors.forename: J J
authors.initials: JJ
authors.lastname: Beitler
authors.affiliation: Otolaryngology Head and Neck Surgery (A.Y.C., J.J.B.).
authors.forename: A Y
authors.initials: AY
authors.lastname: Chen
authors.affiliation: From the Departments of Radiology and Imaging Sciences (J.J.B., A.H.A., A.S.C., K.L.B., P.A.H.).
authors.forename: K L
authors.initials: KL
authors.lastname: Baugnon
authors.affiliation: From the Departments of Radiology and Imaging Sciences (J.J.B., A.H.A., A.S.C., K.L.B., P.A.H.).
authors.forename: A S
authors.initials: AS
authors.lastname: Corey
authors.affiliation: Pathology (K.R.M.).
authors.forename: K R
authors.initials: KR
authors.lastname: Magliocca
authors.affiliation: From the Departments of Radiology and Imaging Sciences (J.J.B., A.H.A., A.S.C., K.L.B., P.A.H.).
authors.forename: P A
authors.identifier: http://orcid.org/0000-0001-8816-4744
authors.initials: PA
authors.lastname: Hudgins
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods