Cancers · 2026
Exploratory Analysis of Quantitative CT Metrics for Predicting Tumor Aggressiveness and Nodal Metastasis in Head and Neck Squamous Cell Carcinoma: A Retrospective Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Barcan Ingrid-Denisa, Costachescu Dan, Stana Ademir Horia, Motofelea Alexandru Catalin, Sima Alexandra Christa, Movila Dana Emilia, Motofelea Nadica, Ciocarlie Tudor, Boia Eugen Radu, Horhat Delia Ioana
Аннотация
BACKGROUND: Preoperative assessment of Head and Neck Squamous Cell Carcinoma (HNSCC) aggressiveness is often hindered by the sampling errors of incisional biopsies. While Contrast-Enhanced Computed Tomography (CECT) is the standard for staging, its potential to serve as a non-invasive complementary radiological tool of the entire tumor volume remains underutilized.
OBJECTIVE: To evaluate the predictive performance of preoperative CECT-derived tumor volume, densitometric values, and morphological features as predictors of histopathological grade and lymph node metastasis (pN) in HNSCC. The primary outcome was predicting lymph node metastasis (pN+), and the secondary outcome was predicting histopathological grade.
METHODS: This retrospective observational study analyzed 42 patients with SCC of the oral cavity, larynx, or maxilla. Quantitative (3D volume, Hounsfield Units [HU], HU Delta) and qualitative (margins, lobulations, necrosis) CT parameters were correlated with definitive histopathology. Diagnostic performance was assessed using Receiver Operating Characteristic (ROC) curve analysis and Spearman's rank correlation.
RESULTS: High-grade tumors (G2/G3) demonstrated significantly larger median volumes (18.1 vs. 2.9 cm3, p = 0.006), lower contrast density (55 vs. 68 HU, p = 0.010), and reduced vascular wash-in (23 vs. 30 HU Delta, p = 0.008) compared to G1 lesions. ROC analysis identified a volume threshold of ≥9.43 cm3 for high-grade disease (AUC = 0.865; sensitivity 67.6%, specificity 100%). For regional metastasis (pN+), tumor volume was the only significant predictor (25.4 vs. 6.2 cm3, p = 0.036), with an optimal cut-off of ≥6.76 cm3 (AUC = 0.769; sensitivity 100%). Strong negative correlations were observed between contrast enhancement and internal necrosis (r = -0.812, p < 0.001).
CONCLUSIONS: Preoperative CECT parameters show promise as non-invasive imaging surrogates of HNSCC aggressiveness. A paradoxical reduction in contrast enhancement characterizes high-grade biology, reflecting disorganized neo-angiogenesis and internal hypoxia. Integrating 3D volumetric analysis and morphological markers shows potential as a complementary exploratory tool that, pending future prospective validation, may support risk stratification and surgical planning alongside traditional histopathological assessment.
OBJECTIVE: To evaluate the predictive performance of preoperative CECT-derived tumor volume, densitometric values, and morphological features as predictors of histopathological grade and lymph node metastasis (pN) in HNSCC. The primary outcome was predicting lymph node metastasis (pN+), and the secondary outcome was predicting histopathological grade.
METHODS: This retrospective observational study analyzed 42 patients with SCC of the oral cavity, larynx, or maxilla. Quantitative (3D volume, Hounsfield Units [HU], HU Delta) and qualitative (margins, lobulations, necrosis) CT parameters were correlated with definitive histopathology. Diagnostic performance was assessed using Receiver Operating Characteristic (ROC) curve analysis and Spearman's rank correlation.
RESULTS: High-grade tumors (G2/G3) demonstrated significantly larger median volumes (18.1 vs. 2.9 cm3, p = 0.006), lower contrast density (55 vs. 68 HU, p = 0.010), and reduced vascular wash-in (23 vs. 30 HU Delta, p = 0.008) compared to G1 lesions. ROC analysis identified a volume threshold of ≥9.43 cm3 for high-grade disease (AUC = 0.865; sensitivity 67.6%, specificity 100%). For regional metastasis (pN+), tumor volume was the only significant predictor (25.4 vs. 6.2 cm3, p = 0.036), with an optimal cut-off of ≥6.76 cm3 (AUC = 0.769; sensitivity 100%). Strong negative correlations were observed between contrast enhancement and internal necrosis (r = -0.812, p < 0.001).
CONCLUSIONS: Preoperative CECT parameters show promise as non-invasive imaging surrogates of HNSCC aggressiveness. A paradoxical reduction in contrast enhancement characterizes high-grade biology, reflecting disorganized neo-angiogenesis and internal hypoxia. Integrating 3D volumetric analysis and morphological markers shows potential as a complementary exploratory tool that, pending future prospective validation, may support risk stratification and surgical planning alongside traditional histopathological assessment.