Can initial apparent diffusion coefficient and tumour volume predict future metastases in treatment-naive patients with laryngeal squamous cell carcinoma. A systematic review.
DOI:
https://doi.org/10.51168/sjhrafrica.v6i9.2226Keywords:
Apparent Diffusion Coefficient (ADC), Laryngeal Squamous Cell Carcinoma (LSCC), Magnetic Resonance Imaging (MRI), Metastasis Prediction, Quantitative Imaging Biomarkers, Tumour Aggressiveness, Tumour Volume (TV)Abstract
Background: Laryngeal squamous cell carcinoma (LSCC) represents a significant portion of head and neck malignancies and is associated with a high risk of regional and distant metastasis. Traditional prognostic indicators such as TNM staging and histopathological grading often fail to capture underlying tumour biology. Quantitative MRI parameters, particularly the apparent diffusion coefficient (ADC) and tumour volume (TV), have emerged as non-invasive biomarkers capable of reflecting tumour aggressiveness and potentially predicting metastatic behaviour.
Aim: To evaluate whether pretreatment ADC and tumour volume derived from MRI can reliably predict future metastases in treatment-naïve patients with LSCC.
Methods: This systematic review followed PRISMA 2020 guidelines. A comprehensive search of major biomedical databases identified observational human studies assessing the relationship between MRI-based ADC or tumour volume and metastatic outcomes in treatment-naïve LSCC. Eligible studies included adults with pretreatment MRI and quantifiable imaging parameters. Due to methodological heterogeneity, findings were synthesized qualitatively. Five studies met the inclusion criteria.
Results & Discussion: Across the five reviewed studies, lower pretreatment ADC values consistently correlated with higher tumour cellularity, increased biological aggressiveness, and greater likelihood of metastasis. Larger tumour volumes were also strongly associated with increased disease burden and higher metastatic risk. Studies that combined ADC and TV demonstrated the highest predictive accuracy, highlighting the complementary value of integrating microstructural (ADC) and morphological (TV) tumour characteristics.
Conclusion: Pretreatment ADC and tumour volume show strong potential as non-invasive MRI-based biomarkers for predicting metastasis in LSCC. Their combined assessment may improve early risk stratification, guide treatment planning, and optimize follow-up. Standardized imaging protocols and prospective multicentre studies are required to validate these findings.
Level of Evidence: Level III (Systematic review of observational prognostic studies).
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