Diagnostic accuracy of MRI and PET/CT for neck staging prior to salvage total laryngectomy

Abstract

Aim: Lymph node (LN) metastases are associated with poor outcomes in patients with recurrent larynx squamous cell carcinoma (LSCC). Neck dissection (ND) is therefore commonly performed along with salvage total laryngectomy (STL). Here, we assess the rate of occult LN metastases and the diagnostic value of MRI and PET/CT for detecting them in recurrent LSCC.

Methods: This retrospective study included patients with recurrent LSCC after primary (chemo)radiotherapy [(C)RT] who were re-staged by MRI and/or PET/CT and treated with STL and ND between 2004 and 2019. The histopathology of ND samples was used as the reference standard.

Results: Forty-one patients were included. The prevalence of occult metastases in MRI-negative and PET/CT-negative neck nodes was between 3.2% and 6.1%. Negative predictive values of neck node re-staging were 93.9% for MRI, 96.8% for PET/CT, and 96.2% for MRI and PET/CT combined.

Conclusion: Both MRI and PET/CT afforded good negative predictive values for nodal staging in patients with recurrent LSCC after (C)RT prior to STL. In selected patients, these radiological modalities, particularly PET/CT, could help to avoid unnecessary surgery to the neck and its associated morbidity.

Keywords

Laryngeal squamous cell carcinoma, recurrence, salvage total laryngectomy, re-staging / neck dissection, MRI, PET/CT, occult nodal metastasis

References

[1] Jemal A,Xu J.Cancer statistics, 2010.CA Cancer J Clin2010;60:277-300

[2] Steuer CE,Parks JR,Saba NF.An update on larynx cancer.CA Cancer J Clin2017;67:31-50

[3] Wolf GT,Hong WK.Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer.N Engl J Med1991;324:1685-90

[4] Forastiere AA,Maor M.Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer.N Engl J Med2003;349:2091-8

[5] Barthel SW.Primary radiation therapy for early glottic cancer.Otolaryngol Head Neck Surg2001;124:35-9

[6] Deng J,Dietrich MS.Prevalence of secondary lymphedema in patients with head and neck cancer.J Pain Symptom Manage2012;43:244-52

[7] Straub JM,Hamilton CD,Shnayder Y.Radiation-induced fibrosis: mechanisms and implications for therapy.J Cancer Res Clin Oncol2015;141:1985-94 PMCID:PMC4573901

[8] Ridner SH,Niermann K,Mannion K.A prospective study of the lymphedema and fibrosis continuum in patients with head and neck cancer.Lymphat Res Biol2016;14:198-205 PMCID:PMC5178009

[9] Bohannon IA,Clemons L,Carroll WR.Management of the N0 neck in recurrent laryngeal squamous cell carcinoma.Laryngoscope2010;120:58-61

[10] Davidson BJ,Harter KW,Cullen KJ.Complications from planned, posttreatment neck dissections.Arch Otolaryngol Head Neck Surg1999;125:401-5

[11] Anschütz L,Elicin O,Caversaccio M.Pectoralis major myofascial interposition flap prevents postoperative pharyngocutaneous fistula in salvage total laryngectomy.Eur Arch Otorhinolaryngol2016;273:3943-9

[12] Deganello A,Bini B.Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?.J Laryngol Otol2014;128:1089-94

[13] Koss SL,Leem TH,Smith RV.Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage.Laryngoscope2014;124:421-8

[14] Bernard SE,Meeuwis CA,Sewnaik A.Elective neck treatment during salvage (pharyngo) laryngectomy.Eur Arch Otorhinolaryngol2019;276:1127-33

[15] Hilly O,Goldhaber D.Elective neck dissection during salvage total laryngectomy--a beneficial prognostic effect in locally advanced recurrent tumours.Clin Otolaryngol2015;40:9-15

[16] Pezier TF,Scotton W.Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy?.J Laryngol Otol2014;128:279-83

[17] Freiser ME,Lo K.Complications and oncologic outcomes following elective neck dissection with salvage laryngectomy for the N0 neck.Am J Otolaryngol2016;37:186-94

[18] Rosko A,Shuman A.Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer.Head Neck2017;39:980-7 PMCID:PMC5392132

[19] Clavien PA,de Oliveira ML.The clavien-dindo classification of surgical complications: five-year experience.Ann Surg2009;250:187-96

[20] TNM classification of malignant tumours. Sobin LH, Gospodarowicz MK, Wittekind C, editors. 7th ed. Wiley-Blackwell: Chichester, West Sussex, UK; Hoboken NJ, 2010.

[21] Sheppard SC,Bojaxhiu B.Multimodal imaging with positron emission tomography/computed tomography and magnetic resonance imaging to detect extracapsular extension in head and neck cancer.Laryngoscope2021;131:E163-9

[22] Mundada P,Lenoir V.Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma.Eur J Radiol2018;101:162-9

[23] Wong WK.Elective management of cervical and parotid lymph nodes in stage N0 cutaneous squamous cell carcinoma of the head and neck: a decision analysis.Eur Arch Otorhinolaryngol2014;271:3011-9

[24] Weiss MH,Isaacs RS.Use of decision analysis in planning a management strategy for the stage N0 neck.Arch Otolaryngol Head Neck Surg1994;120:699-702

[25] Sanabria A,Olsen KD.Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma?.Eur Arch Otorhinolaryngol2014;271:3111-9

[26] Hilly O,Horowitz E,Feinmesser R.Is there a role for elective neck dissection with salvage laryngectomy?.Laryngoscope2013;123:2706-11

[27] Lin DJ,Warner L.Elective neck dissection in patients with radio-recurrent and radio-residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: systematic review and meta-analysis.Head Neck2019;41:4026-35

[28] Gross JH,Simon L.Elective neck dissection during salvage laryngectomy: a systematic review and meta-analysis.Laryngoscope2020;130:899-906

[29] Lin C,Bulbul MG.Elective neck dissection for salvage laryngectomy: a systematic review and meta-analysis.Oral Oncol2019;96:97-104

[30] Kellokumpu-Lehtinen P,Kortekangas A.Radiation-induced morphological changes and radiocurability in squamous cell carcinoma of the head and neck region. A preliminary report.Acta Oncol1990;29:517-20

[31] Doll D,Maak M.Reduced lymph node yield in rectal carcinoma specimen after neoadjuvant radiochemotherapy has no prognostic relevance.World J Surg2009;33:340-7

[32] Yu Y,Rangabashyam MS.Impact of radiotherapy on neck dissection nodal count in patients with head and neck cancer.Laryngoscope2020;130:1947-53

[33] Sheppard SC,Giger R.Lymph node yield and ratio in selective and modified radical neck dissection in head and neck cancer-impact on oncological outcome.Cancers2021;13:2205 PMCID:PMC8125696

[34] Gilbert MR,Kim S.Utility of positron-emission tomography/computed tomography imaging in the management of the neck in recurrent laryngeal cancer.Laryngoscope2012;122:821-5

[35] Finegersh A,Saddawi-Konefka R.Meta-analysis of risk of occult lymph node metastasis in the irradiated, clinically N0 neck.Head Neck2020;42:2355-63

[36] Mehanna H,Ahmed SK.Recurrent head and neck cancer: United Kingdom national multidisciplinary guidelines.J Laryngol Otol2016;130:S181-90 PMCID:PMC4873924

[37] Fleischman GM,Difurio M.Accuracy of ultrasonography-guided fine-needle aspiration in detecting persistent nodal disease after chemoradiotherapy.JAMA Otolaryngol Head Neck Surg2016;142:377-82

[38] Horváth A,Polony G,Tamás L.Accuracy of the preoperative diagnostic workup in patients with head and neck cancers undergoing neck dissection in terms of nodal metastases.Eur Arch Otorhinolaryngol2021;278:2041-6 PMCID:PMC8131330

[39] Hasan Z,Gunaratne DA,Palme CE.Systematic review and meta-analysis of the complications of salvage total laryngectomy.Eur J Surg Oncol2017;43:42-51

[40] Dhawan I,Bhandari R,Bhullar RK.Detection of cervical lymph node micrometastasis and isolated tumor cells in oral squamous cell carcinoma using immunohistochemistry and serial sectioning.J Oral Maxillofac Pathol2016;20:436-44 PMCID:PMC5051292