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. 2014:2014:532095.
doi: 10.1155/2014/532095. Epub 2014 Jun 9.

The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma

Flavio Barchetti  1 , Nicola Pranno  2 , Guglielmo Giraldi  3 , Alessandro Sartori  1 , Silvia Gigli  1 , Giovanni Barchetti  1 , Luigi Lo Mele  1 , Luigi Tonino Marsella  4
Affiliations

The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma

Flavio Barchetti et al. Biomed Res Int. 2014.

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) mm(2)/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10(-3) mm(2)/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.

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Figures

Figure 1
Figure 1
Flow diagram depicting the histopathological findings.
Figure 2
Figure 2
Axial native DWI image at b value of 1000 sec/mm2 (a), color ADC map (b), grey scale ADC map (c), and T1-weighted image (d) of a patient with nasopharynx carcinoma showing two solid lymphadenopathies located at level Ib (arrow) and level IIa (head arrow), respectively. According to morphological criteria the lymph node at level Ib, round shaped and 6 mm in size, was considered to be negative for cancer, while the adenopathy localized at level IIa, oval shaped and with a short transverse diameter of 11 mm, was reported to be suspicious for metastatic involvement. Concerning DWI, level Ib lymph node showed a mean ADC value of 0.690 × 10−3 mm2/sec and was considered suspicious for metastatic involvement, whereas level IIa adenopathy displayed an average ADC value of 1.051 × 10−3 mm2/sec and, therefore, was deemed to be a noncancerous lymphadenopathy. At pathological examination level Ib lymph node showed large intranodal metastatic deposits and level IIa adenopathy was found to be benign.
Figure 3
Figure 3
MR images of a patient with a biopsy proven oropharyngeal squamous cell carcinoma. (a) Axial native DWI image at b value of 1000 sec/mm2, (b) grey scale ADC map, and (c) contrast-enhanced axial fat-suppressed T1-weighted image showing a left-sided lymph node at level IIa. According to morphological criteria the lymph node oval in shape with a maximum transverse diameter of 6 mm was considered to be noncancerous. At DWI the lymph node showed a mean ADC value of 0.861 × 10−3 mm2/sec and was considered to be pathologically involved. (d) Axial native DWI image at b value of 1000 sec/mm2, (e) grey scale ADC map, and (f) contrast-enhanced axial T2-weighted image showing a right-sided lymph node at level Ib. On the basis of morphological criteria the lymph node, round shaped and 9 mm in size, was considered to be suspicious for metastatic involvement. Concerning DWI, the lymph node showed a mean ADC value of 1.213 × 10−3 mm2/sec and was deemed to be a benign lymph node. At pathological examination level IIa lymph node showed intranodal metastatic deposits and level Ib lymph node was found to be benign.
Figure 4
Figure 4
Graph of box plots shows the apparent diffusion coefficient (ADC) values of malignant and benign lymph nodes. The horizontal line in the box represents the median (50th percentile), whereas the top and the bottom represent the 25th and 75th percentile, respectively. The whiskers represent the range from the largest to the smallest measured ADC data. The ADC values of benign lymph nodes are higher compared to those of malignant lymph nodes.
Figure 5
Figure 5
Receiver operating characteristic (ROC) curve comparison for DWI and morphological criteria in the differentiation between benign and metastatic lymphadenopathies.
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