A differentiated thyroid carcinoma-specific graded prognostic assessment for brain metastases: derivation in a 10,306-patient cohort and external validation

Journal of Neuro-Oncology · 2026-04-01

Brain metastases from differentiated thyroid carcinoma (DTC) are rare but associated with significantly worse prognosis compared to extracranial metastatic sites. Existing prognostic models for brain metastases are not tailored to DTC, limiting risk stratification and therapeutic guidance in this population. We conducted a retrospective cohort study of 10,306 patients with DTC treated at a single tertiary cancer center from 2011 to 2025. Patients with radiologically or pathologically confirmed brain metastases were included. Multivariable Cox regression was used to identify independent prognostic factors for overall survival (OS), defined from the time of Brain metastases diagnosis. Based on these factors, we developed the Differentiated Thyroid Cancer Graded Prognostic Assessment (DTC-GPA) and evaluated its discriminatory performance using Harrell’s C-index. External validation was performed using individual-level data from published case series identified via systematic review. Of 10,306 patients with DTC, 146 (1.4%) were found to have brain metastases. The median OS after Brain metastases diagnosis was 20.4 months. ECOG performance status ≥ 2 (HR, 2.67; 95% CI, 1.65–4.30; p < 0.001), presence of multiple brain metastases (HR, 2.30; 95% CI, 1.39–3.82; p = 0.002), and interval ≥ 3 years between primary DTC and Brain metastases diagnosis (HR, 1.84; 95% CI, 1.03–3.27; p = 0.03) were independently associated with worse OS. These three factors formed the DTC-GPA, assigning one point for each favorable variable (range: 0–3). Median OS by score group was 7.7 months (score 0), 22.9 months (score 1), and 61.3 months (score 2–3). The C-index was 0.70 in the derivation cohort and 0.68 in the external validation cohort of 83 patients. The DTC-GPA is the first validated, disease-specific prognostic tool for patients with brain metastases from DTC. This simple, three-point score offers clinically meaningful risk stratification to guide treatment decisions and prognosis estimation in a rare and heterogeneous patient population. • First validated prognostic score for thyroid cancer brain metastases • DTC-GPA stratifies survival with simple 3-point system • External validation confirms clinical applicability Importance of the Study Brain metastases from differentiated thyroid carcinoma (DTC) are rare and lack validated prognostic tools. Existing scores are derived from other cancers and do not reflect the unique biology of DTC. Using the largest single-institution cohort to date and external validation, we developed the Differentiated Thyroid Carcinoma Graded Prognostic Assessment (DTC-GPA), a simple three-factor model. This tool provides disease-specific risk stratification, enabling more accurate survival estimation and informing treatment strategies in a heterogeneous population. The DTC-GPA addresses a longstanding gap in neuro-oncology and will facilitate more consistent patient counseling, clinical trial design, and comparative effectiveness research in this rare group of patients.

Whole-Brain Radiation Therapy for Brain Metastases due to Thyroid Cancer: A Systematic Review and Meta-Analysis

Clinical Oncology · 2026-01-22 · 1 citations

A Bone to Pick: Morphometric Characterization of Black Bone MRI Towards Clinical Implementation

Figshare · 2026-05-05

Poster presented at ACTS Annual Meeting, 4/2026.

Radiation Therapy and Nivolumab with Relatlimab-rmbw Achieved a Complete Response in Metastatic Cutaneous Melanoma to the Orbit

Ophthalmic Plastic and Reconstructive Surgery · 2026-01-12

We present a patient with left orbital metastasis of cutaneous melanoma, treated with 30 Gy in 10 fraction radiation therapy followed by a combination of programmed death-1 inhibitor, nivolumab, and lymphocyte-activation gene inhibitor, relatlimab. The patient achieved a complete response to treatment, with no evidence of recurrence of the orbital mass, 17 months after treatment initiation.

NI-RADS in posttreatment head and neck cancer surveillance: a framework for standardized imaging with clinical impact

Cancer Imaging · 2026-01-10

The Neck Imaging Reporting and Data System (NI-RADS), developed through the American College of Radiology (ACR), provides a standardized framework for interpreting and managing posttreatment imaging in head and neck cancer. Building upon the success of NI-RADS PET/CT, the recently released NI-RADS MRI version 2025 represents a major advancement, introducing modality-specific descriptors and management recommendations tailored to MRI. This review summarizes the history and development of NI-RADS, highlighting both the validated PET/CT framework and the subsequent MRI update. At its core, NI-RADS offers a standardized lexicon for post-treatment findings, a structured reporting format that stratifies risk of disease recurrence, and linked management recommendations. Surveillance imaging is an essential component of post-treatment head and neck cancer care. Evidence strongly supports early imaging surveillance within six months of definitive therapy, whereas the benefits of long-term imaging surveillance remain under-investigated. With the goal of improving patient outcomes, NI-RADS provides a consistent, risk-adaptable framework that supports both clinical decision-making and standardized data collection for future outcomes research. NI-RADS will continue to evolve with advances in oncologic management and imaging technology. Future updates may incorporate ultrasound, advanced imaging techniques, and circulating tumor biomarkers. As surveillance strategies in head and neck cancer advance, NI-RADS is well positioned to serve as the foundation for personalized, risk-based imaging surveillance.

A Bone to Pick: Morphometric Characterization of Black Bone MRI Towards Clinical Implementation

Figshare · 2026-05-05

Poster presented at ACTS Annual Meeting, 4/2026.

Imaging in Head and Neck Oncology

Radiologic Clinics of North America · 2025-07-30

International multispecialty expert physician preoperative identification of extranodal extension in patients with oropharyngeal cancer using computed tomography: Prospective blinded human inter‐observer performance evaluation

Cancer · 2025-03-30 · 6 citations

BACKGROUND: Pathologic extranodal extension (pENE) is a crucial prognostic factor in oropharyngeal cancer (OPC), but determining pENE from imaging has high inter-observer variability. The role of clinician specialty in the accuracy of imaging-detected extranodal extension (iENE) remains unclear. The purpose of this study is to assess the influence of clinician specialty on the accuracy of preoperative iENE detection in human papillomavirus (HPV)-positive OPC using computed tomography (CT) imaging. METHODS: This prospective observational study evaluated pretherapy CT images from 24 HPV-positive OPC patients (30 scans, including duplicates). Thirty-four expert observers (11 radiologists, 12 surgeons, 11 radiation oncologists) assessed iENE and reported radiologic criteria and confidence. Ground-truth pENE status was confirmed pathologically. Accuracy, sensitivity, specificity, area under the receiver operating characteristic curve, and Brier scores were compared across specialties. Logistic regression determined significant predictors of pENE, whereas Fleiss' kappa measured interobserver agreement. RESULTS: Median accuracy was 0.57 (95% CI, 0.39-0.73), with no specialty showing performance beyond chance (median area under the receiver operating characteristic curve, 0.64). Minor differences were noted: surgeons had lower Brier scores (0.26 vs. 0.33, p < .01) and higher sensitivity (0.69 vs. 0.48) compared to radiologists and oncologists. Predictive signs included indistinct capsular contour and nodal necrosis. Interobserver agreement was weak (κ < 0.6). CONCLUSIONS: Diagnostic performance for iENE on CT in HPV-positive OPC remains poor across specialties, with high variability and low accuracy. These findings highlight the need for automated systems or improved imaging methods to enhance iENE assessments.

Advanced Endoscopic Approaches for Skull Base Surgery: A Contemporary Imaging-Focused Review, From the <i>AJR</i> Special Series on Critical Anatomy

American Journal of Roentgenology · 2025-12-31

Endoscopic skull base surgery has become widely accepted due to the advantages of the minimally invasive approach and achievement of outcomes that are comparable to those from open approaches. Given limited visualization of this region on clinical examination, preoperative planning relies heavily on diagnostic imaging to determine the optical surgical approach and the intended extent of resection. Within this context, high-resolution CT and MRI provide valuable information regarding the pathology, its relationship to critical structures, and other pertinent anatomic considerations. This Special Series Review describes the role of imaging in advanced endoscopic endonasal skull base surgeries, addressing clinically relevant normal and variant anatomy, key surgical landmarks, and pertinent red flags that serve as cautionary imaging findings. We discuss common pathologies occurring along these anatomic corridors and outline the core steps for specific surgical approaches. It is essential for interpreting radiologists to have a thorough understanding of the key anatomic structures and their relationships to pathology, to help surgeons select the appropriate EEA corridor, optimize the extent of resection, minimize surgical risk, and determine reconstruction options.

Diagnostic Performance of Ultrasound in Neck Node NI-RADS Category 2

American Journal of Neuroradiology · 2025-02-24 · 2 citations

BACKGROUND AND PURPOSE: The Neck Imaging Reporting and Data System (NI-RADS) scoring system standardized imaging surveillance of head and neck (H&N) cancer with risk classification. A nodal NI-RADS score of 2 on contrast-enhanced CT (CECT) of the neck indicates low suspicion for recurrence/persistent disease, and close follow-up or addition of PET is recommended. The unclear follow-up imaging findings and/or mild FDG uptake raise the patient's anxiety about potential delay in diagnosis and intervention while adding high imaging costs. Therefore, at our institution, diagnostic ultrasound (US)/US-guided fine-needle aspiration (US-FNA) is incorporated into our paradigm. We aim to evaluate US performance in nodal NI-RADS 2 on CECT as an alternative valuable tool in surveillance imaging guidelines. MATERIALS AND METHODS: We conducted a retrospective database search (2019-2024) for patients with primary H&N cancer (excluding thyroid cancer and melanoma), a single index neck node NI-RADS 2 on surveillance neck CECT, and a neck US/US-FNA performed within 3 months afterward for evaluation of the NI-RADS 2 node. We categorized US/US-FNA results as positive or negative and reviewed clinical and imaging follow-up, management, and nodal disease status up to 1 year following US. The incidence of nodal recurrence and US diagnostic performance were evaluated. RESULTS: Of 90 patients, 36 (40%) had normal diagnostic US with no FNA performed and were thus considered negative, and 54 patients (60%) had abnormal US and hence concurrent US-FNA. Eighteen (33.3%) US-FNAs were positive for tumor: 27 with normal lymphoid tissue and 9 with indeterminate cytology (no viable malignant cells, acellular or atypia) were considered negative (66.7%). All positive US-FNAs resulted in management changes. Two patients with normal diagnostic US, 1 with negative FNA, and 1 with indeterminate FNA developed recurrence in these nodes within 1 year. The incidence of US-detected malignancy was 20% in patients with a nodal NI-RADS 2, surpassing the published rate of 14.3%. The sensitivity, accuracy, and negative predictive value of US/US-FNA in detecting tumor recurrence/persistence in nodal NI-RADS 2 are 81.8%, 95.6%, and 94.4%, respectively. CONCLUSIONS: Ultrasound demonstrated good diagnostic performance in the detection of nodal recurrence in patients with NI-RADS 2 on CECT. Its role as an alternative tool in surveillance should be considered.