Radiological assessment of extranodal extension in patients with head and neck squamous cell carcinoma

Abstract

The prognosis of patients with head and neck squamous cell cancer (HNSCC) decreases with the presence of extranodal extension (ENE) in lymph node metastases. Therefore, ENE was introduced in the 8th Edition TNM Classification (TNM8) for Head and Neck Cancer as a staging variable in all HPV-negative HNSCC. Patients with ENE may benefit from adjuvant or even primary chemotherapy and/or radiotherapy. There is a clear discrepancy between the definition of clinical ENE and pathological ENE. In TNM8, the radiological evaluation of ENE only plays a supportive role. Since not all patients with advanced disease will undergo a neck dissection, histologic proof of ENE will not always be available. In these cases, it would be of great help to be able to accurately determine ENE with radiological imaging. In this review, an update is given of the ability of radiological imaging to identify and grade ENE.

Keywords

Head and neck cancer / extranodal extension / TNM8 / radiology / CT / MR

References

[1] Coatesworth AP,MacLennan K.The cause of death in patients with head and neck squamous cell carcinoma.J Laryngol Otol2002;116:269-71

[2] Leemans CR,Nauta JPJ,Snow GB.Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma.Cancer1993;71:452-6

[3] Calhoun KH,Weiss R.Distant metastases from head and neck squamous cell carcinomas.Laryngoscope1994;104:1199-205

[4] Carvalho MB. Quantitative analysis of the extent of extracapsular invasion and its prognostic significance: a prospective study of 170 cases of carcinoma of the larynx and hypopharynx.Head Neck1998;20:16-21

[5] Wreesmann VB,Palmer FL.Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma.Head Neck2016;38 Suppl 1:E1192-9 PMCID:PMC4996672

[6] Clark J,Smith G.Outcome of treatment for advanced cervical metastatic squamous cell carcinoma.Head Neck2005;27:87-94

[7] Lewis JS Jr,Thorstad WL,Haughey BH.Extracapsular extension is a poor predictor of disease recurrence in surgically treated oropharyngeal squamous cell carcinoma.Mod Pathol2011;24:1413-20 PMCID:PMC3925389

[8] Dünne AA,Eisele DW,Moll R.Meta-analysis of the prognostic significance of perinodal spread in head and neck squamous cell carcinomas (HNSCC) patients.Eur J Cancer2006;42:1863-8

[9] de Almeida JR,Khan NM.Treatment implications of postoperative chemoradiotherapy for squamous cell carcinoma of the oral cavity with minor and major extranodal extension.Oral Oncol2020;110:104845

[10] Bernier J,Pajak TF.Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501).Head Neck2005;27:843-50

[11] Alvi A.Extracapsular spread in the clinically negative neck (N0): implications and outcome.Otolaryngol Head Neck Surg1996;114:65-70

[12] Prabhu RS,Magliocca KR.Extent of pathologic extracapsular extension and outcomes in patients with nonoropharyngeal head and neck cancer treated with initial surgical resection.Cancer2014;120:1499-506

[13] Huang SH.Overview of the 8th edition TNM classification for head and neck cancer.Curr Treat Options Oncol2017;18:40

[14] Greenberg JS,Gomez J.Extent of extracapsular spread: a critical prognosticator in oral tongue cancer.Cancer2003;97:1464-70

[15] Shaw RJ,Woolgar JA.Extracapsular spread in oral squamous cell carcinoma.Head Neck2010;32:714-22

[16] Carlton JA,Bauer LB.Computed tomography detection of extracapsular spread of squamous cell carcinoma of the head and neck in metastatic cervical lymph nodes.Neuroradiol J2017;30:222-9 PMCID:PMC5480800

[17] Faraji F,Coquia SF.Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer.Laryngoscope2020;130:1479-86

[18] Lee B,Kim SO.Prognostic value of radiologic extranodal extension in human papillomavirus-related oropharyngeal squamous cell carcinoma.Korean J Radiol2019;20:1266-74 PMCID:PMC6658881

[19] Patel MR,Beitler JJ.Radiographic imaging does not reliably predict macroscopic extranodal extension in human papilloma virus-associated oropharyngeal cancer.ORL J Otorhinolaryngol Relat Spec2018;80:85-95 PMCID:PMC6707079

[20] Randall DR,Hudon ME.Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma.Head Neck2015;37:92-6

[21] Almulla A,Lu L.Radiologic-Pathologic Correlation of extranodal extension in patients with squamous cell carcinoma of the oral cavity: implications for future editions of the TNM classification.Int J Radiat Oncol Biol Phys2018;102:698-708

[22] Chai RL,Johnson JT.Accuracy of computed tomography in the prediction of extracapsular spread of lymph node metastases in squamous cell carcinoma of the head and neck.JAMA Otolaryngol Head Neck Surg2013;139:1187-94

[23] Geltzeiler M,Gleysteen J.Predictors of extracapsular extension in HPV-associated oropharyngeal cancer treated surgically.Oral Oncol2017;65:89-93

[24] Kann BH,Loganadane GV.Pretreatment identification of head and neck cancer nodal metastasis and extranodal extension using deep learning neural networks.Sci Rep2018;8:14036 PMCID:PMC6145900

[25] King AD,Yuen EH.Comparison of CT and MR imaging for the detection of extranodal neoplastic spread in metastatic neck nodes.Eur J Radiol2004;52:264-70

[26] Noor A,Patel S.Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma.J Med Imaging Radiat Oncol2019;63:500-9

[27] Park SI,Suh CH.The diagnostic performance of CT and MRI for detecting extranodal extension in patients with head and neck squamous cell carcinoma: a systematic review and diagnostic meta-analysis.Eur Radiol2021;31:2048-61

[28] Prabhu RS,Hanasoge S.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 Phys2014;88:122-9

[29] Sharma A,Umredkar G.Lymph node central necrosis on the computed tomography as the predictor of the extra capsular spread in metastatic head and neck squamous cell carcinoma.Indian J Otolaryngol Head Neck Surg2017;69:323-32 PMCID:PMC5581765

[30] Souter MA,Clarkson JH,Coates MH.Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma.J Laryngol Otol2009;123:778-82

[31] Url C,Riechelmann H.Radiological detection of extracapsular spread in head and neck squamous cell carcinoma (HNSCC) cervical metastases.Eur J Radiol2013;82:1783-7

[32] Zoumalan RA,Morris LG.Lymph node central necrosis on computed tomography as predictor of extracapsular spread in metastatic head and neck squamous cell carcinoma: pilot study.J Laryngol Otol2010;124:1284-8 PMCID:PMC3005594

[33] Frood R,Barnfield M,Vaidyanathan S.Can MR textural analysis improve the prediction of extracapsular nodal spread in patients with oral cavity cancer?.Eur Radiol2018;28:5010-8

[34] Hao SP.Magnetic resonance imaging versus clinical palpation in evaluating cervical metastasis from head and neck cancer.Otolaryngol Head Neck Surg2000;123:324-7

[35] Kimura Y,Sakihama N,Takahashi H.MR imaging criteria for the prediction of extranodal spread of metastatic cancer in the neck.AJNR Am J Neuroradiol2008;29:1355-9 PMCID:PMC8119143

[36] Lodder WL,van Velthuysen ML.Can extranodal spread in head and neck cancer be detected on MR imaging.Oral Oncol2013;49:626-33

[37] Moreno KF,Lucas FV,Patil YJ.Using 3 Tesla magnetic resonance imaging in the pre-operative evaluation of tongue carcinoma.J Laryngol Otol2017;131:793-800

[38] Steinkamp HJ,Werk M,Felix R.[Extracapsular spread of cervical lymph node metastases: diagnostic relevance of ultrasound examinations].Ultraschall Med2003;24:323-30

[39] Qualliotine JR,Hamper UM.Association of ultrasound characteristics with extranodal extension in metastatic papillary thyroid carcinoma.JAMA Otolaryngol Head Neck Surg2016;142:263-9

[40] Kann BH,Payabvash S.Multi-institutional validation of deep learning for pretreatment identification of extranodal extension in head and neck squamous cell carcinoma.J Clin Oncol2020;38:1304-11

[41] Haider SP,Yarbrough WG.Applications of radiomics in precision diagnosis, prognostication and treatment planning of head and neck squamous cell carcinomas.Cancers Head Neck2020;5:6 PMCID:PMC7197186

[42] Sandulache VC,Kataria P.High-risk TP53 mutations are associated with extranodal extension in oral cavity squamous cell carcinoma.Clin Cancer Res2018;24:1727-33 PMCID:PMC5884733

[43] Johnson DE,Leemans CR,Bauman JE.Head and neck squamous cell carcinoma.Nat Rev Dis Primers2020;6:92 PMCID:PMC7944998

[44] Wang J,Tian Y.Six-gene signature for predicting survival in patients with head and neck squamous cell carcinoma.Aging (Albany NY)2020;12:767-83 PMCID:PMC6977678

[45] Klinakis A.TP53 mutational landscape of metastatic head and neck cancer reveals patterns of mutation selection.EBioMedicine2020;58:102905 PMCID:PMC7393519