Tissue characterization of locoregionally advanced head-and-neck squamous cell carcinoma (HNSCC) using quantified ultrasonography: A prospective phase II study on prognostic relevance

Background and purpose: Information on a patient's prognosis is important for the clinical decision-making process. This study explored the capacity of quantitative ultrasound imaging to increase prognostic information. Materials and methods: High-resolution B-scan and colour-coded duplex-sonography of the neck was prospectively applied to 50 HNSCC-patients stage IVA-B 05/99-01/02 before definite radio-(chemo-)therapy. Every lymph node >1.5 cm was scored for the following Malignancy Criteria: Inhomogeneity, Surface-irregularity, Missing hilar sign, Spherical form, Matting, Aberrant intranodal vessels, Infiltration of surrounding tissue, Intranodal cystic necrosis. Results: Median Overall Survival (OS) was 1 year. High MMCC (Maximal Malignancy Criteria Count in a single node) predicted a poor outcome with a median OS of 8.1 months (MMCC = 7-8, n = 24) vs. 24.7 months for low MMCC (1-6, n = 26, p = 0.0004, logrank). Estimated 1- and 3-year-OS was 25% and 8% for high vs. 69% and 41% for low MMCC. Ten out of eleven living patients (follow-up 2.3-5.3 years) had a low MMCC. Of the clinical parameters determined, only pre-treatment hemoglobin levels <12 g/dl and treatment less radical than chemoradiation to 70 Gy predicted poor OS (univariate p = 0.04 and 0.02, respectively). In multivariate Cox analysis, MMCC continued to significantly predict for OS (p = 0.002) and Disease-Free Survival (p = 0.002). Conclusions: Quantification of nodal ultrasonography offers valuable prognostic information for the conservative management of HNSCC.