Radiology–Pathology Concordance and Prognostication of Nodal Features in pN+ Oral Cavity Cancer

Abstract

Background and PurposeThe aims of our study are to evaluate the diagnostic performance and prognostic value of radiological lymph node (LN) characteristics in pN+ oral cavity squamous carcinoma (OSCC).Materials and MethodspN+ OSCC treated between 2012 and 2020 were included. Preoperative imaging was reviewed by a single radiologist blinded to pathologic findings for the following nodal features: imaging‐positive LN (iN+), laterality and total number, and image‐identified extranodal extension (iENE). The sensitivity of iN+ for pN+ was calculated. The diagnostic performance of other nodal features was evaluated in the iN+ subgroup. The association of radiologic nodal features with overall survival (OS) was evaluated. Inter‐rater kappa for radiologic nodal features was assessed in 100 randomly selected cases.ResultsOf 406 pN+ OSCC, 288 were iN+. The sensitivity of iN+ for pN+ was 71% overall, and improved to 89% for pN+ LN >1.5 cm. Within iN+, sensitivity/specificity for LN size (>3 cm), total LN number (>4), and ENE were 0.44/0.95, 0.57/0.84, and 0.27/0.96, respectively. Sensitivity of iENE was higher in the subset, with major (>2 mm) versus minor (≤2 mm) pENE (43% vs. 13%, p = 0.001). Reduced OS was observed in iN+ versus iN– (p = 0.006), iENE+ versus iENE– (p = 0.004), LN size >3 versus ≤3 cm (p < 0.001), and higher LN number (p < 0.001). Inter‐rater kappa for iN+, laterality, total LN number, and presence of iENE were 0.71, 0.57, 0.78, and 0.69, respectively.ConclusionOur study shows that despite modest sensitivity of most radiological nodal features, the specificity of image‐identified nodal features is high and their prognostic values are retained in pN+ OSCC.Level of EvidenceLevel 3 (retrospective review comparing cases and controls) Laryngoscope, 2024