Accuracy of Computed Tomography in the Prediction of Extracapsular Spread of Lymph Node Metastases in Squamous Cell Carcinoma of the Head and Neck

作者：Raymond Liu Chai, Tanya J. Rath, Jonas Talmadge Johnson, Robert Louis Ferris, Gregory J. Kubicek, Umamaheswar Duvvuri, Barton F. Branstetter · 发表于：JAMA Otolaryngology–Head & Neck Surgery · 年份：2013 · DOI：10.1001/jamaoto.2013.4491 · 被引用次数：105 · 研究领域：Head and Neck Cancer Studies、Esophageal Cancer Research and Treatment、Salivary Gland Tumors Diagnosis and Treatment

IMPORTANCE: At many institutions, computed tomography with iodinated intravenous contrast medium is the preferred imaging modality for staging of the neck in squamous cell carcinoma of the head and neck. However, few studies have specifically assessed the diagnostic accuracy of computed tomography for determining the presence or absence of extracapsular spread (ECS). OBJECTIVE: To determine the accuracy of modern, contrast-enhanced, multidetector computed tomography in the diagnosis of ECS of cervical lymph node metastases from squamous cell carcinoma of the head and neck. DESIGN, SETTING, AND PARTICIPANTS: Retrospective observational study at an academic tertiary referral center among 100 consecutive patients between May 1, 2007, and February 1, 2012, who underwent a lateral cervical neck dissection for squamous cell carcinoma of the head and neck with neck metastases of at least 1 cm in diameter on pathologic assessment. Exclusion criteria included malignant neoplasms other than squamous cell carcinoma, a delay in surgery longer than 6 weeks from the time of staging computed tomography, and prior treatment of the neck or recurrent disease or a second primary. MAIN OUTCOMES AND MEASURES: Each patient was independently assigned a subjective score for the presence of ECS by 2 Certificate of Added Qualification-certified neuroradiologists according to a 5-point scale. Receiver operating characteristic curves were generated, and sensitivity, specificity, accuracy, positive predi...