Journal article
MDADI as a Screening Tool for VFSS-Graded Swallowing Impairment in Head and Neck Cancer Patients
The Laryngoscope
08/25/2026
DOI: 10.1002/lary.70835
PMID: 42639820
Abstract
To determine clinically useful MD Anderson Dysphagia Inventory (MDADI) thresholds associated with Videofluoroscopic swallow study (VFSS)-graded swallowing impairment in head and neck cancer (HNC) patients and to explore whether a reduced-item MDADI could preserve discrimination while minimizing patient burden.
This retrospective cross-sectional study analyzed HNC patients from a prospectively maintained dysphagia surveillance program who completed the MDADI within 120 days of VFSS. Associations between MDADI and VFSS metrics were assessed using Spearman and point-biserial correlations. Swallowing impairment was defined using Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) and Penetration-Aspiration Scale (PAS) with clinically relevant dichotomization. Optimal MDADI composite score thresholds were derived using Youden's J statistic, and exploratory item reduction investigated the ability of a concise subset to preserve discrimination of clinically significant impairment.
A total of 208 patients contributed 470 MDADI-VFSS observations for PAS and 443 for DIGEST (mean follow-up 3.7 years and MDADI-VFSS interval 56 ± 35.9 days). MDADI composite scores showed moderately strong and moderate inverse correlations with DIGEST (r = -0.63, p < 0.001) and PAS (r = -0.50, p < 0.001), respectively, with good discrimination across both outcome definitions (AUC 0.78-0.88). Optimal MDADI thresholds ranged from 74 to 78 with ~74 best identifying DIGEST ≥ 2. A four-item MDADI short form (F3, E3, E4, and P6) showed strong agreement with Composite score (r = 0.96), with good discrimination of DIGEST-defined impairment (AUC = 0.85).
MDADI scores correlate with VFSS-graded impairment in HNC patients. A composite threshold near 74 may serve as a clinically useful screening parameter for identifying patients requiring swallowing evaluation.
Details
- Title: Subtitle
- MDADI as a Screening Tool for VFSS-Graded Swallowing Impairment in Head and Neck Cancer Patients
- Creators
- Zachary G Brumm - University of California, San FranciscoEric A Anyimadu - University of IowaMeera Kohli - University of California, San FranciscoJennifer Silver - University of California, San FranciscoBeatrice Manduchi - The University of Texas MD Anderson Cancer CenterKatherine Hutcheson - The University of Texas MD Anderson Cancer CenterArushi Gulati - University of California, San FranciscoG Elisabeta Marai - University of Illinois ChicagoTyler W Crosby - University of California, San FranciscoClark A Rosen - University of California, San FranciscoVyVy N Young - University of California, San FranciscoGuadalupe Canahuate - University of IowaYue Ma - University of California, San Francisco
- Resource Type
- Journal article
- Publication Details
- The Laryngoscope
- DOI
- 10.1002/lary.70835
- PMID
- 42639820
- NLM abbreviation
- Laryngoscope
- ISSN
- 0023-852X
- eISSN
- 1531-4995
- Publisher
- Wiley
- Language
- English
- Electronic publication date
- 08/25/2026
- Academic Unit
- Electrical and Computer Engineering
- Record Identifier
- 9985221447802771
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