A scoring model based on lymph node-to-primary tumor standardized uptake value ratio aids in classifying neck nodal metastasis risk in patients with head and neck cancer treated by surgery.

OBJECTIVE

Accurate detection of cervical lymph node metastasis in head and neck cancer (HNC) is essential for guiding neck dissection. The lymph node-to-primary tumor maximum standardized uptake value (SUVmax) ratio (NTR), derived from [18F]fluorodeoxyglucose PET/computed tomography ([18F]FDG PET/CT), has emerged as a robust and reproducible imaging biomarker. This study aimed to evaluate the diagnostic value of NTR for predicting cervical nodal metastasis in patients with HNC.

METHODS

This retrospective study included 167 patients with surgically treated HNC who underwent neck dissection. All patients received contrast-enhanced CT/MRI and [18F]FDG PET/CT before treatment. The diagnostic performance was evaluated using histopathology as the reference standard. Clinical and imaging factors were analyzed, and a scoring model was constructed.

RESULTS

On visual interpretation, [18F]FDG PET/CT outperformed CT/MRI, showing higher sensitivity (87.5 vs. 77.4%) and specificity (75.7 vs. 68.6%), but its positive predictive value (PPV) remained suboptimal (69.1%). Multivariate analysis identified SUVmax of cervical lymph nodes (P = 0.049) and NTR (P = 0.038) as independent predictors. A scoring model incorporating these predictors was developed. When visual interpretation was combined with the scoring model, visually positive nodes were stratified into high-risk (PPV: 86.8%), intermediate-risk (PPV: 41.1%), and low-risk (PPV: 36.3%) for refined discrimination of metastatic potential.

CONCLUSION

Integration of visual assessment with an NTR-based scoring model enhances the diagnostic accuracy of [18F]FDG PET/CT in evaluating cervical lymph node metastasis in HNC. This combined approach may improve diagnostic confidence and help minimize unnecessary neck dissections.