title: Predictors of extracapsular extension in HPV-associated oropharyngeal cancer treated surgically.
abstract: Extracapsular extension (ECE) in cervical metastatic lymph nodes remains an indication for adding chemotherapy for patients with oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to identify specific imaging characteristics on computed tomography (CT) scan that are predictive of ECE in order to better risk stratify patients preoperatively.
  
  
  
  A single cohort study was performed using a prospectively collected database of patients with HPV-related OPSCC who underwent transoral robotic surgery with cervical lymphadenectomy. CT scans were assessed for the presence of multiple imaging characteristics, including lymph node size, number of nodes positive, cystic appearance, and border irregularity. Univariable and multivariable analyses were performed to analyze each variable's predictability of pathologic ECE.
  
  
  
  100 patients underwent TORS with cervical lymphadenectomy for OPSCC from 2010 to 2015. Ninety-one percent (21/23) of patients with 3 or more radiologically suspicious nodes were found to have pathologic ECE, which was a significantly greater proportion than patients with fewer suspicious nodes (p<0.001). CT scans with 3 or more radiologically suspicious nodes displayed a sensitivity and specificity of 55% and 94%, respectively with a positive predictive value (PPV) of 91% for ECE. Irregular borders and age were also correlated with ECE on multivariable analysis.
  
  
  
  The presence of 3 or more radiologically suspicious lymph nodes on CT scan has a 91% PPV for any histologic evidence of ECE. The absolute number of radiographically suspicious lymph node metastases may be a useful method for risk-stratifying patients for the presence of ECE.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA; Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. Electronic address: geltzeilermn@upmc.edu.
authors.forename: Mathew
authors.initials: M
authors.lastname: Geltzeiler
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Clayburgh
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gleysteen
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Gross
authors.affiliation: Department of Radiology, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Hamilton
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Andersen
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brickman
mesh_terms: D052685:Alphapapillomavirus / Q000302:isolation & purification*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery / Q000821:virology; D014057:Tomography, X-Ray Computed
keywords: Cervical adenopathy; Extracapsular extension; Head and neck cancer; Head and neck imaging; Head and neck pathology; Head and neck radiology; Human papilloma virus; Oropharyngeal cancer; Squamous cell carcinoma