Abstract
Objective. The aim of this study was to validate the role of diffusion-weighted imaging (DWI) at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). Materials and Methods. Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se) and specificity (Spe) of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference. Results. In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC) value was 0.903 × 10−3 mm2/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10−3 mm2/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC) of 0.964, while morphological criteria displayed an AUC of 0.715. Conclusions. In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection.
Highlights
The detection of cervical lymph node metastases has a pivotal effect for prognosis and treatment planning of patients with head and neck cancers, as this significantly worsens the treatment outcome
Molecular imaging based on positron emission tomography (PET) scanners improves the diagnostic accuracy of conventional imaging techniques
A policy of prophylactic neck treatment, with either radiation therapy or surgery, is widely accepted if the risk of occult metastases is estimated to be above 15%–20% [18,19,20]
Summary
The detection of cervical lymph node metastases has a pivotal effect for prognosis and treatment planning of patients with head and neck cancers, as this significantly worsens the treatment outcome. According to conventional imaging techniques such as ultrasonography, computed tomography (CT), and conventional anatomical magnetic resonance imaging (MRI) based on T1 and T2 weighted sequences, the parameters used are size, shape, and changing in internal architecture of the lymph nodes. Since differences in T1 and T2 relaxation do not enable reliable nodal differentiation, MRI has not yielded any advantage in addition to CT in the detection of small nodal metastases [9]. Conventional MRI, with morphologic criteria for nodal staging limited and similar to those of CT, has generally yielded results that are similar or slightly inferior to those of CT [10]. Molecular imaging based on positron emission tomography (PET) scanners improves the diagnostic accuracy of conventional imaging techniques
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