背景:对于术前评估中没有淋巴结转移(cN0)证据的口腔鳞状细胞癌(OCSCC)患者,没有明确的指南应进行选择性颈淋巴结清扫术(END)和临床监测.
目的:确定亚厘米淋巴结的CT影像特征,以帮助预测病理上淋巴结转移的可能性。
方法:对三级学术医疗中心的cN0OCSCC患者进行回顾性回顾。纳入标准包括选择性颈淋巴结清扫术,术前CT成像和淋巴结内转移性疾病的存在。对照组为病理上无淋巴结转移的患者。评估的CT特征包括不对称的大小,破裂的脂肪门,非对称数字,皮质结节的存在,皮质结节大小,和圆形/椭圆形。我们使用多级混合效应逻辑回归模型评估了CTLN特征与转移之间的关联。使用5倍交叉验证进行模型评估。计算阳性预测值(PPV)和阴性预测值(NPV)。
结果:每个研究和对照组的26例患者被纳入。三级混合效应逻辑回归模型显示圆形/椭圆形(OR=1.39,p=0.01),非对称数(OR=7.20,p=0.005),和破裂的脂肪门(OR=3.31,p=.04)在灵敏度=38.0%的3变量模型中独立预测,特异性=92.0%,PPV=93.8%。
结论:在接受END的cN0OCSCC患者中,圆形/椭圆形,非对称数字,术前CT成像的淋巴结脂肪门破裂是新颖的,并且可以高度预测隐匿性淋巴结疾病。
BACKGROUND: For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance.
OBJECTIVE: To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology.
METHODS: Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated.
RESULTS: 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%.
CONCLUSIONS: In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.