Appraisal of Radiologic Size Criteria for Malignant Lymph Nodes in Parotid Region in Nasopharyngeal Carcinoma: Implication for Parotid‐Sparing <scp>IMRT</scp>
Bibliographic record
Abstract
PURPOSE: We evaluate the appropriateness of current radiology size criteria (short axial diameter, SAD ≥ 10 mm) for malignant nodes in the parotid region (PLN), and appreciate the clinical implications of the Node-Reporting-and-Data-System (Node-RADS) in nasopharyngeal carcinoma (NPC). METHODS AND MATERIAL: NPC patients who received curative IMRT were included. Pre-treatment MRI was reviewed by two radiologists to record the presence/absence, size, and configuration of PLN, and calculated Node-RADS score. Malignant PLN was defined as either fine-needle aspiration (FNA) positive or the occurrence of subsequent out-field in situ PLN failure following parotid-sparing IMRT. RESULTS: Pre-treatment PLN was identified in 74 (11.8%) of 627 consecutive patients. SAD PLNs were 5-6 mm (n = 53, 72%), 6-8 mm (n = 15, 20%), 8-10 mm (n = 4, 5%), and ≥ 10 mm (2, 3%), respectively. FNAs were positive in 6 patients (2 each in SAD 6-8 mm, 8-10 mm, and ≥ 10 mm). Out-field in situ PLN failure occurred in 6 patients: 1 with SAD 5-6 mm, 3 with SAD 6-8 mm, and 2 with SAD 8-10 mm. The risk of PLN being malignant was 1.9% (1/53), 33.3% (5/15), 100% (4/4), and 100% (2/2) in SAD 5-6 mm, 6-8 mm, 8-10 mm, and ≥ 10 mm subsets, respectively. Malignant PLN with Node-RADS score ≥ 4 were 10% (1/10), 45.5% (5/11), and 100% (4/4) in SAD 5-6 mm, 6-8 mm, 8-10 mm subsets, respectively. CONCLUSION: Current radiologic size criteria of ≥ 10 mm for positive PLN should be reduced to ≥ 8 mm. Node-RADS score of 4-5, which includes adverse morphological nodal features, could improve the specificity of identifying malignant PLNs in the 6-8 mm subset.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".