A Scoring System for Prediction of Cervical Lymph Node Metastasis in Patients with Head and Neck Squamous Cell Carcinoma

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Fig 1.
Example of lymph node scoring. CT images show a 71-year-old man with right hypopharyngeal cancer (asterisk, A) in the lymph node at left cervical level 1 (arrow) and right cervical level 2 (arrowhead). Zero points for left cervical level 1 suggest benign lymph nodes (B), whereas 5 points for right cervical level 2 lymph node are calculated following the scoring system (0 points for stage 2 [T-stage], 1 point for 1.5 cm of shortest axial diameter, 1 point for 1.25 of long-to-short ratio, and 3 points for the cystic necrosis, C). The left cervical level 1 lymph node was classified as a benign lymph node, and the surgical specimen confirmed it as a benign lymph node. The lymph node in the right cervical level 2 was classified as high risk for the metastasis, and the surgical specimen proved it as a metastatic lymph node.
Download figure
Open in new tab
Download powerpoint
Fig 2.
Performance of prediction model.
Download figure
Open in new tab
Download powerpoint
Fig 3.
Calibration plot. The calibration plot shows good agreement between the predicted risk and actual risk of lymph node metastasis.

Table 1:

Univariable and multivariable regression models of lymph node metastasis

Variable	Univariable Analysis			Multivariable Analysis
Variable	OR	95% CI	P Value	OR	95% CI	P Value
T-stage
1	Reference			Reference
2	1.13	0.68–1.89	.64	0.97	0.46–2.06	.93
3 or 4	1.59	0.98–2.59	.06	1.86	0.95–3.77	.07
Shortest axial diameter (cm)	41.29	18.09–94.27	<.001	6.69	2.95–17.31	<.001
Longest axial diameter (cm)	6.59	4.12–10.56	<.001
L/S ratio	0.07	0.03–0.14	<.001	0.50	0.22–1.10	.09
Longest longitudinal diameter (cm)	4.87	3.36–7.08	<.001
Conglomeration^a	9.73	3.66–25.84	<.001
Necrosis
No	Reference			Reference
Present	38.99	17.81–85.37	<.001	15.21	6.97–36.60	<.001
Cystic	82.25	24.88–271.89	<.001	21.76	7.51–84.63	<.001
Infiltration^a	75.54	10.26–556.09	<.001
Laterality to primary tumor (ipsilateral vs contralateral)^a	2.27	1.37–3.75	<.001

↵a The reference standard in this study comprised no conglomeration, no infiltration, and no contralateral location to the primary tumor.

Table 2:

Risk scoring system for lymph node metastasis in patients with newly diagnosed HNSCC

Image Findings	Score
T-stage
1 or 2	0
3 or 4	1
Shortest axial diameter (cm)
<1	0
1–2	1
≥2	4
L/S ratio
<1.5	1
≥1.5	0
Necrosis
No	0
Yes	3
Total score	9
Risk classification by total risk score^a
0–1: low risk (≤17% of metastasis)
2–4: intermediate risk (17%∼78% of metastasis)
5–9: high risk (≥78 % of metastasis)

↵a Estimated metastases for the each score in the risk groups were as follows: low-risk group (score zero, 7% and score one, 17 %), intermediate-risk group (score two, 35%; score three, 58%; and score four, 78%), and high-risk group (score five, 90%; score six, 96%; score seven, 98%; score eight, 99%; and score nine, 100%).