Contrast-enhanced computer tomography (CT) with concordant sonography as sufficient early detection tools for recurrent and persistent cervical metastases after (chemo)radiotherapy (CRT)

Introduction After primary (C)RT of head and neck squamous cell carcinomas (HNSCC), the post-therapeutic treatment strategy of the neck differs.

Materials and methods In this retrospective study (2012 – 2022) 112 patients were included, who initially received RT (n = 58), or CRT (n = 54) followed by salvage ND. Patients with recurrent primary tumors and no suspicious imaging results regarding neck metastases, who received prophylactic ND were also embedded in this study. The results of contrast-enhanced CT, MRI, sonography, and PET-CT were evaluated for residual/recurrent cervical lymph node metastasis and divided into N0/N+. These results were compared to the histopathologic results. This analysis made it possible to calculate the sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of the different types of imaging.

Results 168 neck dissection specimens were analyzed. CT (n=144) revealed a sensitivity of 93%, a specificity of 70%, an NPV of 96%, a PPV of 58%, and an overall accuracy of 77%. By adding sonography (n=125) and concordant imaging results the values increased to 97%, 77%, 99%, 65%, and 83% respectively. Sonography alone (n=167) showed results of 90%, 72%, 94%, 59%, and 78% respectively. The MRI (n=18) revealed values of 75%, 60%, 75%, 60%, and 67%. PET-CT (n= 11) showed 100 % sensitivity, 0 % specificity, no determinable NPV, 18 % PPV, and 18 % overall accuracy.

Conclusion  The contrast-enhanced CT and complementary sonography are sufficient imaging modalities for determining post-therapeutic recurrent or persistent cervical lymph node metastasis. In concordant negative imaging results, a continuing observational strategy might be applicable. The use of PET-CT should be reevaluated in a larger study population.

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Artikel online veröffentlicht:
12. Mai 2023