Affiliation:
1. Emory University School of Medicine Atlanta Georgia USA
2. Department of Radiology and Imaging Sciences Emory University Atlanta Georgia USA
3. Department of Otolaryngology – Head and Neck Surgery Winship Cancer Institute, Emory University Atlanta Georgia USA
Abstract
AbstractIntroductionOccult nodal disease (OND) during clinically‐N0 salvage total laryngectomy (TL) can be detected with the Neck‐Imaging‐Reporting‐and‐Data‐Systems (NI‐RADS). However, some patients will still have OND revealed on final pathology.MethodsA retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features.ResultsAmong 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI‐RADS 2; the rest scored 1.ConclusionsOn re‐review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.