Table 7.
Systematic review of literature for diagnostic accuracy of imaging-based ENE versus pathological ENE as gold standard and its clinical implication.
| Authors | HNSCC sub site and sample size | Number of (rENE+) and (pENE+) | Factors considered for rENE | Accuracy of rENE with gold standard as pENE [sensitivity/specificity (%)] | Inference/Clinical Application |
|---|---|---|---|---|---|
| Url et al. (11) | HNSCC (49) | (Examiner 1: 15 and Examiner 2: 16)* (17) | a) Apparent fat and soft tissue infiltration b) Infiltration of muscle, carotid sheath |
Examiner 1: 73/91 and Examiner 2: 76/91 |
High specificity |
| Prabhu et al. (19) | HNSCC (432) | (46), (87) | a) Irregular borders and/or perinodal fat stranding b) Invasion of adjacent structures |
23/98 30/99.7 |
High specificity |
| Aiken et al. (20) | OSCC (111) | (29), (28) | a) Irregular borders and/or perinodal fat stranding b) Invasion of adjacent structures |
68/88 | High specificity Central necrosis is best criteria |
| Maxwell et al. (21) | HPV+ OPC (65) | (19), (38) | a) Nodal capsular contour irregularity b) Poorly defined nodal margins c) Loss of intervening fat planes d) Invasion of adjacent structures |
55–77/70–85 | Not reliable in HPV+ cases |
| Carlton et al. (17) | HNSCC (93) | (Examiner 1: 32 and Examiner 2: 37) *, (56) |
a) Indistinct nodal margin b) Infiltration into adjacent tissue c) Irregular nodal enhancement d) Matted nodes e) Central necrosis |
Examiner 1: 57/81; Examiner 2: 66/76 |
Moderate specificity |
| Almulla et al. (10) | OSCC (483) | (55), (114) | a) Ill-defined Lymph node borders b) Matted nodes |
52/96 | High specificity |
| Noor et al. (18) | HPV + OPC (80) | (Likely ECS: 15 & 14; Definitely ECS 11 & 14)* | a) Assessing internal characteristics b) Capsule contour c) Perinodal fat stranding d) Invasion into surrounding structures |
Examiner 1: 56.5/73.3; Examiner 2: 60.9/66.7 |
High specificity |
| Faraji et al. (22) | HPV+ OPC (73) | (NA), (32) | a) Indistinct capsular contours b) Irregular nodal margins c) Perinodal fat stranding d) Perinodal fat planes e) Nodal necrosis f) Intranodal cysts g) Nodal matting |
Irregular nodal margins: 45/ 94 absence of perinodal fat plane: 87/ 50 |
Presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively. |
| Moon et al. (7) | HNSCC (117) | (30), (NA) | Enhancement, thickening, and irregularity of nodal rim; blurred border and/or infiltration mahajan of the adjacent fat or other soft tissue planes; and infiltration of the sternocleidomastoid muscle, internal jugular vein, or carotid artery |
NA | Pretreatment rENE is not only associated with CCRT response but also act as independent prognostic factor for survival in patients with HNSCC treated with CCRT. |
| Kang-Hosing Fan et al. (13) | HPC (355) | (171),(NA) | Infiltration of adjacent fat/muscles, irregular nodal surface, or irregular capsular enhancement |
NA | rENE considered an adverse prognostic marker for survival in patients with HPC treated by primary CCRT and correlates with inferior RFS regardless of N stage. |
| Mahajan et al. (current study) | LAHNSCC (354) | (140), (NA) | a) Capsular irregularity with fat stranding b) Capsular irregularity with fat invasion c) Capsular irregularity with muscle/vessel invasion |
NA | rENE can be reliably used as an independent prognostic marker for survival in patients with LAHNSCC. |
HNSCC, head and neck squamous cell carcinoma; HPV + OPC, HPV-associated oropharyngeal carcinoma; OPC, oropharyngeal carcinoma; OSCC, oral cavity squamous cell carcinoma; HPC, hypopharyngeal cancer; pENE, pathological extranodal extension; NA, not applicable. *Two separate examiners value.