Validity of Computed Tomography Scoring Model for Prediction of Cervical Nodal Metastasis in Patients with Head and Neck Squamous Cell Carcinoma

Abstract

Background: Squamous cell carcinoma of the head and neck is a common and often fatal cancer that can emerge from a variety of anatomic locations. An accurate and comprehensive assessment of lymph node metastasis in patients with head and neck squamous cell carcinoma (HNSCC) is necessary in daily practice. Objective: This study aimed to predict cervical nodal metastasis by using multidetector computed tomography (MDCT) scoring model in patients with HNSCCC. Patients and Methods: A cross sectional study in Zagazig University Hospital during the period from November 2019 to April 2020, included 76 lymph nodes from thirty patients with HNSCC. We analyzed preoperative CT images of lymph nodes including diameter, ratio of long to short axis diameter, necrosis and T stage of the primary tumor. The reference standard comprised pathologic results. Multivariable logistic regression analysis was performed to evaluate the risk scoring system. Results: A 9-point risk scoring system (shortest axial diameter, L/S ratio, necrosis and T stage). The most common site was RT buccal region (5 cases), followed by base of tongue (3 cases), followed by RT sided of tongue (cases 5), followed by LT sided of tongue (1 case), followed by tip of nose (1 case), followed by lower lip (4 cases), followed by RT mandibular ramus (3 cases), followed by Epiglottis, true, false vocal cord, aryepiglottic fold (4 cases), followed by LT sided floor of mouth (2 cases), followed by LT external auditory meatus (1 case) and swelling in posterior scalp. Conclusion: A simple 9 point risk scoring system using CT characteristic of lymph nodes and tumors for HNSCC could be feasible to stratify the risk of cervical lymph node metastasis with high diagnostic accuracy.