{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T18:56:50Z","timestamp":1785783410908,"version":"3.56.0"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: This study aimed to evaluate and compare the diagnostic performance of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) in detecting metastatic cervical lymph nodes in patients with oral squamous cell carcinoma (OSCC), with a particular focus on radiologically indeterminate lymph nodes. Materials and Methods: A retrospective analysis was conducted on OSCC patients who underwent CT, MRI, and PET-CT imaging prior to surgery, followed by histopathologic confirmation. Lymph nodes were categorized as metastatic, indeterminate, or benign based on imaging criteria specific to each modality. Diagnostic accuracy, sensitivity, and specificity were calculated using histopathology as the reference standard. Results: After excluding lymph nodes classified as indeterminate on preoperative imaging, CT demonstrated an accuracy of 83.6%, sensitivity of 51.9%, and specificity of 92.4% for metastatic lymph node detection. MRI and PET-CT showed comparable accuracies (81.6% and 80.8%, respectively) and identical sensitivities (53.9%). In contrast, among radiologically indeterminate lymph nodes, most lesions identified on CT and MRI were histopathologically benign, whereas PET-CT yielded very few indeterminate nodes, all of which were benign. For benign node identification, PET-CT exhibited the highest sensitivity (86.8%) but lower specificity (55.8%), while CT and MRI demonstrated more balanced specificity (73.1%) with lower sensitivity. Logistic regression confirmed SUVmax as a significant predictor of malignancy (p &lt; 0.001; odds ratio 1.71, 95% CI: 1.48\u20132.35), and ROC analysis demonstrated strong discriminative performance (AUC = 0.88), with an optimal SUVmax cutoff of 3.6. Conclusion: While CT remains highly specific, PET-CT offers greater sensitivity in detecting benign and indeterminate lymph nodes, making it a valuable adjunct in preoperative assessment. SUVmax serves as a strong quantitative indicator for metastatic involvement. A multimodal imaging approach may enhance diagnostic accuracy, particularly in cases where lymph nodes lack definitive radiologic features.<\/jats:p>","DOI":"10.3390\/jcm15041610","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T09:55:31Z","timestamp":1771494931000},"page":"1610","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Indeterminate Lymph Nodes Assessment in Oral Squamous Cell Carcinoma Using CT, MRI, and PET-CT: A Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5791-7387","authenticated-orcid":false,"given":"Jihye","family":"Ryu","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9017-7287","authenticated-orcid":false,"given":"Su-Yi","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0678-2499","authenticated-orcid":false,"given":"Jae-Yeol","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Dental and Life Science Institute & Dental Research Institute, School of Dentistry, Pusan National University, Yangsan 43241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Takamura, M., Nikkuni, Y., Hayashi, T., Katsura, K., Nishiyama, H., Yamazaki, M., Maruyama, S., and Tanuma, J.I. (2023). Comparing the Diagnostic Accuracy of Ultrasonography, CT, MRI, and PET\/CT in Cervical Lymph Node Metastasis of Oral Squamous Cell Carcinoma. Biomedicines, 11.","DOI":"10.3390\/biomedicines11123119"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Madsen, C.B., Rohde, M., Gerke, O., Godballe, C., and Sorensen, J.A. (2023). Diagnostic Accuracy of Up-Front PET\/CT and MRI for Detecting Cervical Lymph Node Metastases in T1-T2 Oral Cavity Cancer-A Prospective Cohort Study. Diagnostics, 13.","DOI":"10.3390\/diagnostics13223414"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s12070-015-0837-4","article-title":"Diagnostic Efficacy of Computed Tomography in Detecting Cervical Metastases in Clinically N0 Head and Neck Squamous Cell Carcinoma","volume":"68","author":"Bhargava","year":"2016","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/S0720-048X(99)00145-X","article-title":"Lymph node metastases: CT and MRI","volume":"33","year":"2000","journal-title":"Eur. J. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Alsibani, A., Alqahtani, A., Almohammadi, R., Islam, T., Alessa, M., Aldhahri, S.F., and Al-Qahtani, K.H. (2024). Comparing the Efficacy of CT, MRI, PET-CT, and US in the Detection of Cervical Lymph Node Metastases in Head and Neck Squamous Cell Carcinoma with Clinically Negative Neck Lymph Node: A Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13247622"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1177\/19714009231224447","article-title":"CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study","volume":"37","author":"Morisada","year":"2024","journal-title":"Neuroradiol. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1067\/mhn.2000.105252","article-title":"Magnetic resonance imaging versus clinical palpation in evaluating cervical metastasis from head and neck cancer","volume":"123","author":"Hao","year":"2000","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1179\/acb.2006.039","article-title":"Evaluation of metastatic lymph nodes in head and neck cancer: A comparative study between palpation, ultrasonography, ultrasound-guided fine needle aspiration cytology and computed tomography","volume":"61","author":"Rottey","year":"2006","journal-title":"Acta Clin. Belg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.nic.2012.08.011","article-title":"Pitfalls in the staging of cervical lymph node metastasis","volume":"23","author":"Saindane","year":"2013","journal-title":"Neuroimaging Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"W17","DOI":"10.2214\/AJR.12.8960","article-title":"Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: Tips, traps, and a systematic approach","volume":"200","author":"Hoang","year":"2013","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_11","first-page":"8030","article-title":"Preservation of level IIb lymph nodes during supraomohyoid neck dissection for clinically node-negative oral squamous cell carcinoma","volume":"12","author":"Wu","year":"2020","journal-title":"Am. J. Transl. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/s12663-024-02425-9","article-title":"To Evaluate the Efficacy of Methylene Blue in Identification of Neck Sentinel Lymph Nodes in Oral Squamous Cell Carcinoma","volume":"24","author":"Ustad","year":"2025","journal-title":"J. Maxillofac. Oral. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1148\/radiology.182.3.1535890","article-title":"Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT","volume":"182","author":"Yousem","year":"1992","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"961","DOI":"10.2214\/ajr.158.5.1566697","article-title":"Detection of metastases in cervical lymph nodes CT and MR criteria and differential diagnosis","volume":"158","author":"Som","year":"1992","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1148\/radiology.192.3.8058923","article-title":"Detection of lymph node metastases in the neck: Radiologic criteria","volume":"192","author":"Castelijns","year":"1994","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"van Staalduinen, E.K., Matthews, R., Khan, A., Punn, I., Cattell, R.F., Li, H., Franceschi, A., Samara, G.J., Czerwonka, L., and Bangiyev, L. (2023). Improved Cervical Lymph Node Characterization among Patients with Head and Neck Squamous Cell Carcinoma Using MR Texture Analysis Compared to Traditional FDG-PET\/MR Features Alone. Diagnostics, 14.","DOI":"10.3390\/diagnostics14010071"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s003300101102","article-title":"Imaging of lymphadenopathy in the neck","volume":"12","author":"Castelijns","year":"2002","journal-title":"Eur. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1148\/radiology.207.1.9530307","article-title":"Comparison of CT and MR imaging in staging of neck metastases","volume":"207","author":"Curtin","year":"1998","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1002\/hed.2880140302","article-title":"Role of modern imaging in decision-making for elective neck dissection","volume":"14","author":"Feinmesser","year":"1992","journal-title":"Head Neck"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.canrad.2019.06.006","article-title":"Post-treatment follow-up of head and neck cancer patients","volume":"23","author":"Graff","year":"2019","journal-title":"Cancer Radiother."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Caldarella, C., De Risi, M., Massaccesi, M., Micciche, F., Bussu, F., Galli, J., Rufini, V., and Leccisotti, L. (2024). Role of (18)F-FDG PET\/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications. Cancers, 16.","DOI":"10.3390\/cancers16101905"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.2967\/jnumed.107.044362","article-title":"18F-FDG PET for mediastinal staging of lung cancer: Which SUV threshold makes sense?","volume":"48","author":"Hellwig","year":"2007","journal-title":"J. Nucl. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.oooo.2019.09.005","article-title":"Accuracy of (18) F-FDG PET\/CT in Detection of Neck Metastases of Oral Squamous Cell Carcinoma in Patients Without Large Palpable Lymph Nodes","volume":"129","author":"Niu","year":"2020","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1749-8090-8-63","article-title":"The correlation of SUVmax with pathological characteristics of primary tumor and the value of Tumor\/Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients","volume":"8","author":"Koksal","year":"2013","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/s00247-017-3835-8","article-title":"FDG uptake in cervical lymph nodes in children without head and neck cancer","volume":"47","author":"Vali","year":"2017","journal-title":"Pediatr. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/jnci\/djn125","article-title":"18F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in patients with head and neck squamous cell carcinoma: A meta-analysis","volume":"100","author":"Kyzas","year":"2008","journal-title":"J. Natl. Cancer Inst."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1610\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T10:02:33Z","timestamp":1771495353000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1610"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041610"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041610","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}