RT Journal Article
SR Electronic
T1 Diagnostic Performance of Ultrasound in Neck Node NIRADS Category 2
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP ajnr.A8717
DO 10.3174/ajnr.A8717
A1 Dagher, Richard
A1 Khalaf, Alexander
A1 Calle, Susana
A1 Dagher, Samir A.
A1 Shah, Komal B.
A1 Juliano, Amy
A1 Aiken, Ashley H.
A1 Learned, Kim O.
YR 2025
UL http://www.ajnr.org/content/early/2025/02/24/ajnr.A8717.abstract
AB 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.