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Research ArticleORIGINAL RESEARCH

Diagnostic Performance of Ultrasound in Neck Node NIRADS Category 2

Richard Dagher, Alexander Khalaf, Susana Calle, Samir A. Dagher, Komal B. Shah, Amy Juliano, Ashley H. Aiken and Kim O. Learned
American Journal of Neuroradiology February 2025, ajnr.A8717; DOI: https://doi.org/10.3174/ajnr.A8717
Richard Dagher
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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Alexander Khalaf
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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Susana Calle
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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Samir A. Dagher
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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Komal B. Shah
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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Amy Juliano
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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Ashley H. Aiken
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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Kim O. Learned
From the Department of Neuroradiology (R.D., A.K., S.C., S.A.D., K.S., K.O.L.), The University of Texas MD Anderson Cancer Center, Houston, TX< USA. Department of Radiology (A.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Radiology and Imaging Sciences (A.H.A.), Emory University School of Medicine, Atlanta, GA, USA.
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ABSTRACT

BACKGROUND AND PURPOSE: The NI-RADS scoring system standardized imaging surveillance of head and neck (H&N) cancer with risk classification. A nodal NIRADS score of 2 on contrast-enhanced CT (CECT) of the neck indicates low suspicion for recurrence/persistent disease and close follow-up or addition of PET are recommended. The unclear follow-up imaging findings and/or mild FDG uptake raise patient’s anxiety of potential delay in diagnosis and intervention while adding high imaging cost. Therefore, at our institution, diagnostic US/US-guided fine needle aspiration (US-FNA) is incorporated in our paradigm. We aim to evaluate US performance in nodal NI-RADS 2 on CECT as alternative valuable tool in surveillance imaging guidelines.

MATERIALS AND METHODS: We conducted a retrospective database search (2019-2024) for patients with primary H&N cancer (excluding thyroid cancer and melanoma), a single index neck node NI-RADS 2 on surveillance CECT neck, and a neck US/US-FNA performed within 3 months afterwards for evaluation of the NI-RADS 2 node. We categorized US/US-guided FNA results as positive or negative and reviewed clinical and imaging follow-up, management and nodal disease status up to 1 year following US. The incidence of nodal recurrence and US diagnostic performance were evaluated.

RESULTS: Of 90 patients, 36 (40%) had normal diagnostic US with no FNA performed and were thus considered negative, and 54 patients (60%) had abnormal US and hence concurrent US-FNA. 18 (33.3%) US-FNAs were positive for tumor; 27 with normal lymphoid tissue and 9 with indeterminate cytology (no viable malignant cells, acellular or atypia) were considered negative (66.7%). All positive US-FNAs resulted in management changes. 2 patients with normal diagnostic US, 1 with negative FNA and 1 with indeterminate FNA developed recurrence in these nodes within 1 year. The incidence of US-detected malignancy was 20% in patients with a nodal NIRADS 2, surpassing the published rate of 14.3%. The sensitivity, accuracy and NPV of US/US-FNA in detecting tumor recurrence/persistence in nodal NI-RADS 2 are 81.8%, 95.6% and 94.4% respectively.

CONCLUSIONS: Ultrasound demonstrated good diagnostic performance in the detection of nodal recurrence in patients with NI-RADS 2 on CECT. Its role as an alternative tool in surveillance should be considered.

ABBREVIATIONS: CECT = contrast-enhanced CT; CEMR = contrast-enhanced MR; ENE = extranodal extension; FNA = fine-needle aspiration; NI-RADS = Neck Imaging Reporting and Data System; NPV = negative predictive value; PPV = positive predictive value; SCC = squamous cell carcinoma; RVU = relative value units; US = ultrasound.

Footnotes

  • The authors declare no conflicts of interest related to the content of this article.

  • © 2025 by American Journal of Neuroradiology

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Accepted Manuscript
Richard Dagher, Alexander Khalaf, Susana Calle, Samir A. Dagher, Komal B. Shah, Amy Juliano, Ashley H. Aiken, Kim O. Learned
Diagnostic Performance of Ultrasound in Neck Node NIRADS Category 2
American Journal of Neuroradiology Feb 2025, ajnr.A8717; DOI: 10.3174/ajnr.A8717

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Accepted Manuscript
Diagnostic Performance of Ultrasound in Neck Node NIRADS Category 2
Richard Dagher, Alexander Khalaf, Susana Calle, Samir A. Dagher, Komal B. Shah, Amy Juliano, Ashley H. Aiken, Kim O. Learned
American Journal of Neuroradiology Feb 2025, ajnr.A8717; DOI: 10.3174/ajnr.A8717
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