Quantifying the Pharyngeal Wall Thickness on Modified Barium Swallow Studies: A Scoping Review and Reliability Study
- 1University of Texas MD Anderson Cancer Center
Abstract
PurposePosterior pharyngeal wall (PPW) thickening is a common structural manifestation of treatment-related internal lymphedema in patients with head and neck cancer and can be evaluated using lateral videofluoroscopic images acquired during modified barium swallow (MBS) studies. However, no standardized method currently exists for quantitative measurement.
MethodsThis two-phase methodological study first conducted a scoping review to characterize existing approaches to PPW thickness measurement and identify the principal factors contributing to variation in PPW thickness measurement. Eight studies were identified with variation observed across these measurement factors. An empirical reliability study was then performed using 107 MBS studies from 93 Head and Neck Cancer patients. Two independent raters annotated 10 anatomical landmarks on pre-swallow and post-swallow resting frames, and a computer-assisted algorithm quantitatively generated seven candidate PPW thickness measurements based on different vertebral reference points and measurement directions. Reliability was assessed intraclass correlation coefficients (ICCs).
ResultsInter-rater reliability was highest for the measurement originating from the midpoint of C3 and extending perpendicular to the anterior C3 surface (ICC, 0.78; 95% CI, 0.72-0.83). Among the normalization references, C2-C4 vertebral length demonstrated greater reliability than C3 vertebral length, with an ICC of 0.88 (95% CI, 0.85-0.91). No significant differences were observed between pre-swallow and post-swallow PPW thickness measurements across the evaluated approaches.
ConclusionsThese findings provide a methodological foundation for more standardized and reliable quantification of PPW thickness, with potential to expand the role of MBS from the functional evaluation of swallowing to include quantitative characterization of pharyngeal structural abnormalities.
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BibTeX
@misc{mao2026quantifying,
title = {{Quantifying the Pharyngeal Wall Thickness on Modified Barium Swallow Studies: A Scoping Review and Reliability Study}},
author = {S. Mao and H. McMillan and J. D. Leone and C. E. A. Barbon and S. N. Buoy and K. K. Brock and S. Lai and M. A. Naser and C. D. Fuller and K. A. Hutcheson and InHANCE Research Program Working Group},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.17.26365811},
url = {https://www.medrxiv.org/content/10.64898/2026.10.17.26365811v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Quantifying the Pharyngeal Wall Thickness on Modified Barium Swallow Studies: A Scoping Review and Reliability Study
AU - S. Mao
AU - H. McMillan
AU - J. D. Leone
AU - C. E. A. Barbon
AU - S. N. Buoy
AU - K. K. Brock
AU - S. Lai
AU - M. A. Naser
AU - C. D. Fuller
AU - K. A. Hutcheson
AU - InHANCE Research Program Working Group
PY - 2026
DA - 2026/10/17
PB - medRxiv
DO - 10.64898/2026.10.17.26365811
UR - https://www.medrxiv.org/content/10.64898/2026.10.17.26365811v1
AB - PurposePosterior pharyngeal wall (PPW) thickening is a common structural manifestation of treatment-related internal lymphedema in patients with head and neck cancer and can be evaluated using lateral videofluoroscopic images acquired during modified barium swallow (MBS) studies. However, no standardized method currently exists for quantitative measurement. MethodsThis two-phase methodological study first conducted a scoping review to characterize existing approaches to PPW thickness measurement and identify the principal factors contributing to variation in PPW thickness measurement. Eight studies were identified with variation observed across these measurement factors. An empirical reliability study was then performed using 107 MBS studies from 93 Head and Neck Cancer patients. Two independent raters annotated 10 anatomical landmarks on pre-swallow and post-swallow resting frames, and a computer-assisted algorithm quantitatively generated seven candidate PPW thickness measurements based on different vertebral reference points and measurement directions. Reliability was assessed intraclass correlation coefficients (ICCs). ResultsInter-rater reliability was highest for the measurement originating from the midpoint of C3 and extending perpendicular to the anterior C3 surface (ICC, 0.78; 95% CI, 0.72-0.83). Among the normalization references, C2-C4 vertebral length demonstrated greater reliability than C3 vertebral length, with an ICC of 0.88 (95% CI, 0.85-0.91). No significant differences were observed between pre-swallow and post-swallow PPW thickness measurements across the evaluated approaches. ConclusionsThese findings provide a methodological foundation for more standardized and reliable quantification of PPW thickness, with potential to expand the role of MBS from the functional evaluation of swallowing to include quantitative characterization of pharyngeal structural abnormalities.
ER -