title: Radiologic extranodal spread and matted nodes: Important predictive factors for development of distant metastases in patients with high-risk head and neck cancer.
abstract: Different clinical high-risk factors for the development of distant metastases have been identified but not tested in the same cohort of patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  
  In 145 patients with previously identified clinical high risk factors, the presence of extranodal spread (ENS) and matted node on pretreatment CT (n = 96) and/or MRI (n = 111) were determined.
  
  
  
  Of 145 patients, ENS was detected in 87 patients (60.0%) and matted nodes in 53 patients (36.6%). Kaplan-Meier curves for presence or absence of ENS (on CT and/or MRI) and matted nodes (on CT) differ significantly. In a Cox regression analysis, only ENS was a significant risk factor (hazard ratio [HR] = 3.3; 95% confidence interval [CI] = 2.0-5.5; p < .001).
  
  
  
  In patients with high-risk HNSCC with clinically (palpably or radiologically) ENS and matted nodes, both determined radiologically, are high risk factors for development of distant metastases. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1452-E1458, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.|Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, UMC Utrecht, Utrecht, The Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: Department of Radiology, Advent Hospital Willemstad, Curaçao, The Netherlands.
authors.forename: Redina
authors.initials: R
authors.lastname: Ljumanovic
authors.affiliation: Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Hazewinkel
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Birgit I
authors.initials: BI
authors.lastname: Witte
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors
keywords: distant metastases; extranodal spread; head and neck squamous cell carcinoma; matted nodes; risk factors