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What Is the Best Imaging Modality to Predict Extracapsular Nodal Extension?

  • Majid KhanEmail author
  • Benyamin Deldar
  • Nafi Aygun
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

The extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. Postoperative chemoradiation is superior to postoperative radiotherapy alone in patients with histologically proven extracapsular spread. If extracapsular spread can be detected preoperatively, patients may favor primary chemoradiation instead of primary surgery plus postoperative chemoradiation.

There is no consensus about which imaging modality is best for diagnosis of extra-capsular spread and in this chapter we review the literature and describe the strengths and limitation of each imaging modality and give a personal opinion about how this important finding should be viewed and correlated both clinically and histopathologically.

Keywords

Extracapsular spread (ECS) Head and neck squamous cell cancer (HNSCC) Oro-pharyngeal cancer (OPC) Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound (USG) Positron emission tomography (PET) Time intensity curve (TIC) Dynamic contrast enhancement (DCE) 

References

  1. 1.
    Shaw RJ, et al. Extracapsular spread in oral squamous cell carcinoma. Head Neck. 2010;32(6):714–22.PubMedGoogle Scholar
  2. 2.
    Dunne AA, Muller HH, et al. Meta-analysis of the prognostic significance of perinodal spread in head and neck squamous cell carcinomas (HNSCC) patients. Eur J Cancer. 2006;42:1863–8.CrossRefGoogle Scholar
  3. 3.
    Liu B, Guan C, Ji WY, Pan ZM. Extracapsular spread in ipsilateral neck metastasis: an important prognostic factor in laryngeal cancer. Chin Med Sci J. 2006;21:86–9.PubMedGoogle Scholar
  4. 4.
    Van den Brekel MW, Lodder WL, Stel HV, et al. Observer variation in the histopathologic assessment of extranodal tumor spread in lymph node metastases in the neck. Head Neck. 2012;34(6):840–5.CrossRefGoogle Scholar
  5. 5.
    American College of American Pathologists. Protocol for the examination of specimens from patients with carcinomas of the lip and oral cavity. 1 May 2015. www.cap.org.
  6. 6.
    Brannan AG, Johnstone PA, Cooper J. Extracapsular tumor extension in cervical lymph nodes: reconciling the literature and seer data. Head Neck. 2011;33(4):525–8.CrossRefGoogle Scholar
  7. 7.
    Lewis JS Jr, et al. Extracapsular extension is a poor predictor of disease recurrence in surgically treated oropharyngeal squamous cell carcinoma. Mod Pathol. 2011;24(11):1413–20.CrossRefGoogle Scholar
  8. 8.
    Myers JN, Greenberg JS, Mo V, Roberts D. Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer. 2001;92:3030–6.CrossRefGoogle Scholar
  9. 9.
    Jan JC, Hsu WH, Liu SA, et al. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011;69:396–404.CrossRefGoogle Scholar
  10. 10.
    Kimura Y, Sumi M, et al. MR imaging criteria for the prediction of extranodal spread of metastatic cancer in the neck. Am J Neuroradiol. 2008;29:1355–9.CrossRefGoogle Scholar
  11. 11.
    Mancuso AA, et al. Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part II: Pathology. Radiology. 1983;148(3):715–23.CrossRefGoogle Scholar
  12. 12.
    Steinkamp HJ, et al. The extracapsular spread of cervical lymph node metastases: the diagnostic value of computed tomography. Rofo. 1999;170(5):457–62.CrossRefGoogle Scholar
  13. 13.
    King AD, et al. Comparison of CT and MR imaging for the detection of extranodal neoplastic spread in metastatic neck nodes. Eur J Radiol. 2004;52(3):264–70.CrossRefGoogle Scholar
  14. 14.
    Yousem DM, et al. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT. Radiology. 1992;182(3):753–9.CrossRefGoogle Scholar
  15. 15.
    Souter MA, et al. Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma. J Laryngol Otol. 2009;123(7):778–82.CrossRefGoogle Scholar
  16. 16.
    Kann BH, Buckstein M, Carpenter TJ, Bakst R, et al. Radiographic extracapsular extension and treatment outcomes in locally advanced oropharyngeal carcinoma. Head Neck. 2014;36(12):1689–94.CrossRefGoogle Scholar
  17. 17.
    Randall DR, et al. Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma. Head Neck. 2015;37(1):92–6.CrossRefGoogle Scholar
  18. 18.
    Zoumalan RA, et al. Lymph node central necrosis on computed tomography as predictor of extracapsular spread in metastatic head and neck squamous cell carcinoma: pilot study. J Laryngol Otol. 2010;124(12):1284–8.CrossRefGoogle Scholar
  19. 19.
    Don DM, et al. Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope. 1995;105(7 Pt 1):669–74.CrossRefGoogle Scholar
  20. 20.
    Snyderman NL, et al. Extracapsular spread of carcinoma in cervical lymph nodes. Impact upon survival in patients with carcinoma of the supraglottic larynx. Cancer. 1985;56(7):1597–9.CrossRefGoogle Scholar
  21. 21.
    Prabhu RS, et al. Accuracy of computed tomography for predicting pathologic nodal extracapsular extension in patients with head-and-neck cancer undergoing initial surgical resection. Int J Radiat Oncol Biol Phys. 2014;88(1):122–9.CrossRefGoogle Scholar
  22. 22.
    Lodder WL, et al. Can extranodal spread in head and neck cancer be detected on MR imaging. Oral Oncol. 2013;49(6):626–33.CrossRefGoogle Scholar
  23. 23.
    Sumi M, Nakamura T. Extranodal spread in the neck: MRI detection on the basis of pixel-based time-signal intensity curve analysis. J Magn Reson Imaging. 2011;33(4):830–8. https://doi.org/10.1002/jmri.22454.CrossRefGoogle Scholar
  24. 24.
    Ishii J, et al. Ultrasonography and computed tomography of extracapsular invasion in cervical lymph nodes of squamous cell carcinoma in the oral cavity. J Med Ultrason (2001). 2004;31(2):75–9.Google Scholar
  25. 25.
    Liao CT, et al. Pretreatment primary tumor SUVmax measured by FDG-PET and pathologic tumor depth predict for poor outcomes in patients with oral cavity squamous cell carcinoma and pathologically positive lymph nodes. Int J Radiat Oncol Biol Phys. 2009;73(3):764–71.CrossRefGoogle Scholar
  26. 26.
    Joo YH, et al. Extracapsular spread in hypopharyngeal squamous cell carcinoma: diagnostic value of FDG PET/CT. Head Neck. 2013;35(12):1771–6.CrossRefGoogle Scholar
  27. 27.
    Joo YH, et al. Extracapsular spread and FDG PET/CT correlations in oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2013;42(2):158–63.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeuroradiologyJohns Hopkins HospitalBaltimoreUSA

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