Abstract
ObjectiveTo determine the most appropriate radiologic criteria of metastatic retropharyngeal lymph nodes (RLNs) in patients with maxillary sinus cancer (MSC).Materials and methodsWe retrospectively evaluated 16 consecutive patients who underwent magnetic resonance imaging (MRI) before and after the treatment of locally advanced squamous cell carcinoma of the maxillary sinus. The minimal and maximal diameters of all RLNS were recorded. RLNs were classified as metastatic on the basis of the MRI follow-up (f/u). RLNs were considered non-metastatic if stable disease continued until the final MRI f/u and metastatic in cases with different evaluations (complete response, partial response, progressive disease) determined using Response Evaluation Criteria in Solid Tumours (RECIST) ver. 1.1. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to assess the accuracy of various criteria in the diagnosis of metastatic RLNs.ResultsOf the 34 RLNs in 16 cases observed on pretreatment MRI, 7 were classified as metastatic RLNs and 27 as non-metastatic RLNs. Using the radiologic criteria, metastatic RLNs tended to be diagnosed more accurately with the minimal axial diameter than with the maximal axial diameter (AUC; 0.97 vs. 0.73, p = 0.06). The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 5 mm or larger, with an accuracy of 94.1% (32 of 34).ConclusionsThe most appropriate radiologic criterion of metastatic RLNs in MSC is a minimal axial diameter of 5 mm or longer.
Highlights
Maxillary sinus cancer (MSC) is a relatively rare disease, with an incidence of 1 per 100 000 person-years, and accounts for 3% of all head and neck cancers
Of the 34 retropharyngeal lymph nodes (RLNs) in 16 cases observed on pretreatment magnetic resonance imaging (MRI), 7 were classified as metastatic RLNs and 27 as non-metastatic RLNs
The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 5 mm or larger, with an accuracy of 94.1% (32 of 34)
Summary
Maxillary sinus cancer (MSC) is a relatively rare disease, with an incidence of 1 per 100 000 person-years, and accounts for 3% of all head and neck cancers. The combination of radiation therapy and intra-arterial (IA) chemotherapy is a promising treatment for patients who had unresectableMSC or refused surgery because of its high control rate and high OS [3, 4] This is a popular treatment in Japan, and it is not a standard method, we have observed good results in patients treated with locally advanced MSC using this combination [5]. The irradiation field setting of the retropharyngeal lymph node (RLN) region is important because it affects the radiation dose of the pharyngeal contractile muscle and may cause severe acute mucositis and late dysphagia in ENI [9,10,11,12]. Radiologic criteria for metastatic RLNs in MSC have not been established
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