Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma

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Background.Oral cavity squamous cell carcinoma (SCC) represents the most common SCC affecting the head and neck region. Long-term survival of patients with oral cavity SCC is adversely affected by lymph node metastasis and further decreased by the presence of lymph node extracapsular spread (ECS).Methods.Using a case-control design, preoperative CT scans from patients with oral cavity SCC and metastatic lymphadenopathy were evaluated by 2 independent neuroradiologists, blinded to the study, for a number of radiologic parameters, including central node necrosis. Multivariate logistic regression was used to identify parameters independently predicting pathologic ECS.Results.For both neuroradiologists, central node necrosis was a significant predictor of ECS, with high interrater agreement (kappa = 0.71). On multivariate analysis, only central node necrosis independently predicted ECS (odds ratio [OR] = 12.1; 95% confidence interval [CI] = 1.24–119). Central node necrosis predicted ECS with 91% sensitivity and 88% negative predictive values.Conclusion.Our findings suggest that central node necrosis on preoperative CT scans is strongly associated with the presence of ECS. © 2014 Wiley Periodicals, Inc. Head Neck37: 92–96, 2015

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