# Predictive Factors of Malignancy in Cervical Paragangliomas: A Retrospective Study

## TL;DR

This study identifies seven risk factors that help predict if cervical paragangliomas are likely to be malignant and spread.

## Contribution

The study introduces seven new predictive factors for metastatic cervical paragangliomas using clinical and imaging data.

## Key findings

- Seven risk factors were identified, including necrosis, extracapsular extension, and abnormal lymph node uptake.
- These factors can help clinicians identify aggressive tumors and adjust treatment strategies.
- The study used logistic regression to determine the predictive value of various clinical and imaging features.

## Abstract

Early predictive factors of metastatic cervical paragangliomas (cPG) are lacking.

This multicenter retrospective study included patients with at least one cPG. Metastatic cPG were defined by the histological presence of lymph node metastases or distant metastases. Clinical, radiological, intraoperative, histological, and mutational status characteristics were collected. Predictive factors of metastatic cPG were searched using logistic regression.

Sixty‐seven patients were included, corresponding to 86 cPG; 12.8% of these were metastatic. The seven newly identified risk factors were: presence of necrosis (OR = 12.36, 95% CI: [3.03–55.66]), extracapsular extension (OR = 33.42, 95% CI: [2.48–4752.00]), and pathological lymph nodes (OR = 25.00, 95% CI: [3.96–276.07]) on morphological imaging (MRI and/or CT); heterogeneous tumor uptake (OR = 15.5, 95% CI: [2.31–143.68]) and abnormal lymph node uptake (OR = 16.5, 95% CI: [2.04–174.94]) on functional imaging (FDG–PET–CT); invasion of adjacent tissues (OR = 34.63, 95% CI: [3.82–4602.65]) and sacrifice of noble structures (OR = 75.9, 95% CI: [7.99–10230.73]) in patients who underwent surgery.

These risk factors could be combined to promptly identify aggressive cPG and adapt therapeutic strategy.