Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral XXXX .

@entity1 @entity1544 @entity957 @entity39
BACKGROUND AND PURPOSE: The increasing impact of diagnosing extracapsular spread by using imaging, especially in @entity1 with @entity957 , highlights the need to rigorously evaluate the diagnostic accuracy of imaging. Previous analysis suggested 62.5%-80.9% sensitivity and 60%-72.7% specificity. Our goals were to evaluate the accuracy of imaging in diagnosing extracapsular spread in a cohort of @entity1 with @entity1544 (pathologic confirmation of extracapsular spread routinely available), as a proxy for @entity957 , and to independently assess the reliability of imaging features (radiographic lymph node @entity39 , irregular borders/stranding, gross invasion, and/or node size) in predicting pathologically proven extracapsular spread. MATERIALS AND METHODS: One hundred eleven consecutive @entity1 with untreated @entity1544 and available preoperative imaging and subsequent lymph node dissection were studied. Two neuroradiologists blinded to pathologically proven extracapsular spread status and previous radiology reports independently reviewed all images to evaluate the largest suspicious lymph node along the expected drainage pathway. Radiologic results were correlated with pathologic results from the neck dissections. RESULTS: Of 111 @entity1 , 29 had radiographically determined extracapsular spread. Pathologic examination revealed that 28 of 111 (25%) had pathologically proven extracapsular spread. Imaging sensitivity and specificity for extracapsular spread were 68% and 88%, respectively. Radiographs were positive for lymph node @entity39 in 84% of the @entity1 in the pathology-proven extracapsular spread group and negative in only 7% of those in the pathologically proven extracapsular spread-negative group. On logistic regression analysis, @entity39 (P = .001), irregular borders (P = .055), and gross invasion (P = .068) were independently correlated with pathologically proven extracapsular spread. CONCLUSIONS: Although the specificity of cross-sectional imaging for extracapsular spread was high, the sensitivity was low. Combined logistic regression analysis found that the presence of @entity39 was the best radiologic predictor of pathologically proven extracapsular spread, and irregular borders and gross invasion were nearly independently significant.
