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García-Curdi F, Lois-Ortega Y, Muniesa-Del Campo A, Andrés-Gracia A, Sebastián-Cortés JM, Vallés-Varela H, Lambea-Sorrosal JJ. Impact Of PET/CT On Treatment In Patients With Head And Neck Squamous Cell Carcinoma. OTOLARYNGOLOGIA POLSKA 2024; 78:29-34. [PMID: 38623858 DOI: 10.5604/01.3001.0054.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
<b><br>Introduction:</b> Although PET/CT is effective for staging HNSCC, its impact on patient management is somewhat controversial. For this reason, we considered it necessary to carry out a study in order to verify whether PET/CT helps to improve the prognosis and treatment in patients. This study was designed to address the impact of PET-FDG imaging when used alongside CT in the staging and therapeutic management of patients with HNSCC.</br> <b><br>Material and methods:</b> Data was collected from 169 patients diagnosed with HNSCC with both CT and PET/CT (performed within a maximum of 30 days of each other). It was evaluated whether discrepancies in the diagnosis of the two imaging tests had impacted the treatment.</br> <b><br>Results:</b> The combined use of CT and PET/CT led to a change in the treatment of 67 patients, who represented 39.7% of the sample. In 27.2% of cases, it entailed a change in the type of treatment which the patient received. In 3.0% of the cases, using both diagnostic tests led to modifications of the therapeutic intention of our patients.</br> <b><br>Conclusions:</b> Using PET/CT in addition to the conventional imaging method in staging resulted in more successful staging and more appropriate therapeutic decision-making.</br>.
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Affiliation(s)
| | | | - Ana Muniesa-Del Campo
- Department of Animal Pathology, Faculty of Veterinary Sciences, University of Zaragoza, Spain
| | - Alejandro Andrés-Gracia
- Department of Nuclear Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Héctor Vallés-Varela
- Department of Otorhinolaryngology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Soffers F, Helsen N, Van den Wyngaert T, Carp L, Hoekstra OS, Goethals L, Martens M, Deben K, Spaepen K, De Bree R, De Geeter F, Zwezerijnen GJC, Van Laer C, Maes A, Lenssen O, Stroobants S. Dual time point imaging in locally advanced head and neck cancer to assess residual nodal disease after chemoradiotherapy. EJNMMI Res 2022; 12:34. [PMID: 35695940 PMCID: PMC9192834 DOI: 10.1186/s13550-022-00905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background FDG-PET/CT has a high negative predictive value to detect residual nodal disease in patients with locally advanced squamous cell head and neck cancer after completing concurrent chemoradiotherapy (CCRT). However, the positive predictive value remains suboptimal due to inflammation after radiotherapy, generating unnecessary further investigations and possibly even surgery. We report the results of a preplanned secondary end point of the ECLYPS study regarding the potential advantages of dual time point FDG-PET/CT imaging (DTPI) in this setting. Standardized dedicated head and neck FDG-PET/CT images were obtained 12 weeks after CCRT at 60 and 120 min after tracer administration. We performed a semiquantitative assessment of lymph nodes, and the retention index (RI) was explored to optimize diagnostic performance. The reference standard was histology, negative FDG-PET/CT at 1 year, or > 2 years of clinical follow-up. The time-dependent area under the receiver operator characteristics (AUROC) curves was calculated. Results In total, 102 subjects were eligible for analysis. SUV values increased in malignant nodes (median SUV1 = 2.6 vs. SUV2 = 2.7; P = 0.04) but not in benign nodes (median SUV1 = 1.8 vs. SUV2 = 1.7; P = 0.28). In benign nodes, RI was negative although highly variable (median RI = − 2.6; IQR 21.2), while in malignant nodes RI was positive (median RI = 12.3; IQR 37.2) and significantly higher (P = 0.018) compared to benign nodes. A combined threshold (SUV1 ≥ 2.2 + RI ≥ 3%) significantly reduced the amount of false-positive cases by 53% (P = 0.02) resulting in an increased specificity (90.8% vs. 80.5%) and PPV (52.9% vs. 37.0%), while sensitivity (60.0% vs. 66.7%) and NPV remained comparably high (92.9% vs. 93.3%). However, AUROC, as overall measure of benefit in diagnostic accuracy, did not significantly improve (P = 0.62). In HPV-related disease (n = 32), there was no significant difference between SUV1, SUV2, and RI in malignant and benign nodes, yet this subgroup was small. Conclusions DTPI did not improve the overall diagnostic accuracy of FDG-PET/CT to detect residual disease 12 weeks after chemoradiation. Due to differences in tracer kinetics between malignant and benign nodes, DTPI improved the specificity, but at the expense of a loss in sensitivity, albeit minimal. Since false negatives at the 12 weeks PET/CT are mainly due to minimal residual disease, DTPI is not able to significantly improve sensitivity, but repeat scanning at a later time (e.g. after 12 months) could possibly solve this problem. Further study is required in HPV-associated disease.
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Affiliation(s)
- Frederik Soffers
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Otto S Hoekstra
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Michel Martens
- Department of Radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Kristof Deben
- Department of Otolaryngology, Jessa Hospital, Hasselt, Belgium
| | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Remco De Bree
- Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - G J C Zwezerijnen
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carl Van Laer
- Department Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Olivier Lenssen
- Department of Oral and Maxillofacial Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Lee SW, Kim SJ. Is Delayed Image of 18F-FDG PET/CT Necessary for Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer Patients? Clin Nucl Med 2022; 47:414-421. [PMID: 35234195 DOI: 10.1097/rlu.0000000000004110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic accuracies of dual-time-point (DTP) 18F-FDG PET/CT for detection of mediastinal lymph node (LN) metastasis in non-small cell lung cancer (NSCLC) patients through a systematic review and meta-analysis. PATIENTS AND METHODS The PubMed, Cochrane database, and EMBASE database, from the earliest available date of indexing through October 31, 2021, were searched for studies evaluating diagnostic performance of DTP 18F-FDG PET/CT for detection of metastatic mediastinal LN in NSCLC patients. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves. RESULTS Ten studies (758 patients) were included in the current study. In patient-based analysis, early image showed a sensitivity of 0.76 and a specificity of 0.75. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.71. In LN-based analysis, early image showed a sensitivity of 0.80 and a specificity of 0.83. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.87. Retention index or %ΔSUVmax is superior to early or delayed images of DTP 18F-FDG PET/CT for detection of mediastinal LN metastasis. CONCLUSIONS Dual-time-point 18F-FDG PET/CT showed a good diagnostic performances for detection of metastatic mediastinal LNs in NSCLC patients. Early and delayed images of DTP 18F-FDG PET/CT revealed similar diagnostic accuracies for LN metastasis. However, retention index or %ΔSUVmax is superior to early or delayed images of DTP 18F-FDG PET/CT for detection of mediastinal LN metastasis in NSCLC patients. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of DTP 18F-FDG PET/CT for mediastinal LN staging in NSCLC patients.
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Affiliation(s)
- Sang Woo Lee
- From the Department of Nuclear Medicine, Kyungpook National University, Chilgok Hospital and School of Medicine, Daegu
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Incidental uptake of fluorodeoxyglucose in the Waldeyer's ring and risk of oropharyngeal malignancy. Eur Arch Otorhinolaryngol 2021; 279:2657-2664. [PMID: 34570264 PMCID: PMC8986689 DOI: 10.1007/s00405-021-07089-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/12/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE Fluorodeoxyglucose (FDG) positron emission tomography (PET) is increasingly used to diagnose and stage malignancy. The aim of this article is to investigate the significance of incidental FDG uptake in the Waldeyer's ring and to assess its value in predicting clinically occult oropharyngeal malignancy. METHODS All FDG-PET/CT scans performed in Imperial College NHS Foundation Trust, UK between January 2012 and November 2018 were included. Patients with known or suspected oropharyngeal malignancy or lymphoma were excluded. Minimum follow-up was 12 months. RESULTS A total of 724 scans revealed oropharyngeal uptake of FDG. Of these, 102 were included in the study. Most patients (62.1%) were scanned as part of staging for other malignancies. Oropharyngeal FDG uptake was asymmetrical in 57.3% of the cases. Uptake was more common in the tonsils (56.3%), followed by the tongue base (31.1%) and both sites (12.6%). In 41.7% of reports, appearance was described as likely physiological; however, 52.4% of reports advised direct visualisation, clinical correlation or ENT opinion. Only 24.3% (25/102) of patients were referred and seen by ENT, 14.6% (15/102) of which had an interval PET scan and 8.7% (9/102) proceeded to tissue diagnosis. There was one oropharyngeal cancer identified and one unexpected metastasis from esophageal cancer. CONCLUSION Incidental uptake on PET/CT in the oropharynx is common. However, malignancy is rare (1.9%) and, when present, is associated with high SUVmax and asymmetrical uptake. Imaging results must be correlated clinically. These patients should be seen by an ENT specialist yet most may not require further investigations.
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Sumner W, Kim SS, Vitzthum L, Moore K, Atwood T, Murphy J, Miyauchi S, Califano JA, Mell LK, Mundt AJ, Sharabi AB. End of treatment cone-beam computed tomography (CBCT) is predictive of radiation response and overall survival in oropharyngeal squamous cell carcinoma. Radiat Oncol 2021; 16:147. [PMID: 34372887 PMCID: PMC8351145 DOI: 10.1186/s13014-021-01871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Image guidance in radiation oncology has resulted in significant improvements in the accuracy and precision of radiation therapy (RT). Recently, the resolution and quality of cone beam computed tomography (CBCT) for image guidance has increased so that tumor masses and lymph nodes are readily detectable and measurable. During treatment of head and neck squamous cell carcinoma (HNSCC), on-board CBCT setup imaging is routinely obtained; however, this CBCT imaging data is not utilized to predict patient outcomes. Here, we analyzed whether changes in CBCT measurements obtained during a course of radiation therapy correlate with responses on routine 3-month follow-up diagnostic imaging and overall survival (OS). MATERIALS/METHODS Patients with oropharyngeal primary tumors who received radiation therapy between 2015 and 2018 were included. Anatomical measurements were collected of largest nodal conglomerate (LNC) at CT simulation, end of radiation treatment (EOT CBCT), and routine 3-month post-RT imaging. At each timepoint anteroposterior (AP), mediolateral (ML) and craniocaudal (CC) measurements were obtained and used to create a 2-dimensional (2D) maximum. RESULTS CBCT data from 64 node positive patients were analyzed. The largest nodal 2D maximum and CC measurements on EOT CBCT showed a statistically significant correlation with complete response on 3-month post-RT imaging (r = 0.313, p = 0.02 and r = 0.318, p = 0.02, respectively). Furthermore, patients who experienced a 30% or greater reduction in the CC dimension had improved OS (Binary Chi-Square HR 4.85, p = 0.028). CONCLUSION Decreased size of pathologic lymph nodes measured using CBCT setup imaging during a radiation course correlates with long term therapeutic response and overall survival of HNSCC patients. These results indicate that CBCT setup imaging may have utility as an early predictor of treatment response in oropharyngeal HNSCC.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Cone-Beam Computed Tomography/methods
- Female
- Follow-Up Studies
- Humans
- Image Processing, Computer-Assisted/methods
- Male
- Middle Aged
- Organs at Risk/radiation effects
- Oropharyngeal Neoplasms/diagnostic imaging
- Oropharyngeal Neoplasms/mortality
- Oropharyngeal Neoplasms/pathology
- Oropharyngeal Neoplasms/radiotherapy
- Prognosis
- Radiotherapy Dosage
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Image-Guided/methods
- Radiotherapy, Image-Guided/mortality
- Radiotherapy, Intensity-Modulated/methods
- Radiotherapy, Intensity-Modulated/mortality
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Whitney Sumner
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
| | - Sangwoo S Kim
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Lucas Vitzthum
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
| | - Kevin Moore
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
| | - Todd Atwood
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
| | - James Murphy
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Sayuri Miyauchi
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
| | - Joseph A Califano
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
- Department of Surgery, Division of Otolaryngology, University of California, San Diego, La Jolla, CA, USA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Sciences, San Diego Moores Cancer Center, University of California, 3855 Health Sciences Drive, MC 0843, La Jolla, CA, 92093, USA.
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
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Huber GF. Opportunities and Limits in Salvage Surgery in Persistent or Recurrent Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13102457. [PMID: 34070089 PMCID: PMC8158391 DOI: 10.3390/cancers13102457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022] Open
Abstract
Except for HPV-induced cancers of the oropharynx, survival rates in patients with squamous cell carcinoma of the head and neck (HNSCC) have not changed substantially over the last decades. Salvage surgery plays an important role where primary treatment was unsuccessful since 50% of advanced-stage patients relapse after nonsurgical primary treatment. Depending on a variety of factors, a considerable number of patients in whom primary treatment was not successful can still be cured by salvage surgery. It is the goal of this review to elucidate these factors with the aim to counsel patients and their relatives realistically about the chances of being cured.
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Affiliation(s)
- Gerhard Frank Huber
- HNO-Klinik, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland; or
- Zentrum für Ohren-, Nasen-, Hals- und Plastische Gesichtschirurgie, Klinik Hirslanden, Witellikerstrasse 40, 8032 Zürich, Switzerland
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Graham MM. Quantification of Radiotracer Uptake Into Tissue. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Stanisz I, Janik S, Grasl MC, Erovic BM. Panendoscopy during follow‐up in laryngeal carcinoma patients after radiotherapy. Head Neck 2020; 42:3601-3608. [DOI: 10.1002/hed.26433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/30/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Isabella Stanisz
- Department of Otolaryngology ‐ Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Stefan Janik
- Department of Otolaryngology ‐ Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Matthäus Christoph Grasl
- Department of Otolaryngology ‐ Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Boban M. Erovic
- Department of Otolaryngology ‐ Head and Neck Surgery Medical University of Vienna Vienna Austria
- Institute of Head and Neck Diseases Evangelical Hospital Vienna Vienna Austria
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Pietrzak AK, Kazmierska J, Marszalek A, Golusinski P, Heydrych A, Wiechec K, Cholewinski W. Dual-time-point PET/CT study protocol can improve the larynx cancer diagnosis. Rep Pract Oncol Radiother 2020; 25:533-538. [PMID: 32477019 DOI: 10.1016/j.rpor.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/20/2020] [Indexed: 01/24/2023] Open
Abstract
Aim To evaluate whether the sequential dual-time-point fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP 18F-FDG PET/CT) study improves the differential diagnosis in the larynx. Background In some cases, the clinical and metabolic similarity of laryngitis and larynx cancer make differential diagnostics difficult when performing standard 18F-FDG PET/CT examinations; therefore, an additional study protocol performance seems to be of reasonable value. Materials and methods 90 patients (mean age: 61 ± 11 years, range: 41-84 years): 23 women (mean age: 63 ± 10 years, range: 51-84 years) and 67 men (mean age: 61 ± 11 years, range: 41-80 years) underwent delayed 18F-FDG PET/CT examinations at 60 and 90 min post intravenous injection (p.i.) of the radiopharmaceutical 18F-FDG. We compared the metabolic activity of 90 structures divided into following groups: normal larynx (30 patients), laryngitis (30 lesions) and larynx cancer (30 tumors) with maximal and mean standardized uptake value (SUVmax, SUVmean) and the retention index (RI-SUVmax). We used the receiver operating characteristics (ROC) curve to evaluate the SUVmax cut-off values. Results The SUVmax cut-off value at 60 and 90 min p.i. of 2.3 (sensitivity/specificity: 96.4%/100%) and 2.4 (94.2%/100%), respectively, distinguished normal and abnormal metabolic activity in the larynx. When laryngitis and tumors were compared, the SUVmax cut-off values obtained after initial and delayed imaging were 3.6 (87.5%/52.0%) and 6.1 (58.3%/84%), respectively. The RI-SUVmax of 1.3% (71.4%/88.1%) suggested abnormality, while RI-SUVmax of 6.6%, malignant etiology (75.0%/80.0%). Conclusions In this study, the sequential DTP scanning protocol improved the sensitivity and specificity of the PET/CT method in terms of differential diagnosis within the larynx.
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Affiliation(s)
- Agata Karolina Pietrzak
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland.,Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Joanna Kazmierska
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland
| | - Andrzej Marszalek
- Poznan University of Medical Sciences and the Greater Poland Cancer Center, Garbary 15, 61-866 Poznan, Poland
| | - Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Poland
| | - Aleksandra Heydrych
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland.,Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Katarzyna Wiechec
- Department of Clinical Psychology, University of Medical Sciences, Poznan, Poland
| | - Witold Cholewinski
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland.,Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
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Hohenstein NA, Chan JW, Wu SY, Tahir P, Yom SS. Diagnosis, Staging, Radiation Treatment Response Assessment, and Outcome Prognostication of Head and Neck Cancers Using PET Imaging. PET Clin 2020; 15:65-75. [DOI: 10.1016/j.cpet.2019.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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11
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Beichel RR, Ulrich EJ, Smith BJ, Bauer C, Brown B, Casavant T, Sunderland JJ, Graham MM, Buatti JM. FDG PET based prediction of response in head and neck cancer treatment: Assessment of new quantitative imaging features. PLoS One 2019; 14:e0215465. [PMID: 31002689 PMCID: PMC6474600 DOI: 10.1371/journal.pone.0215465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/02/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is now a standard diagnostic imaging test performed in patients with head and neck cancer for staging, re-staging, radiotherapy planning, and outcome assessment. Currently, quantitative analysis of FDG PET scans is limited to simple metrics like maximum standardized uptake value, metabolic tumor volume, or total lesion glycolysis, which have limited predictive value. The goal of this work was to assess the predictive potential of new (i.e., nonstandard) quantitative imaging features on head and neck cancer outcome. Methods This retrospective study analyzed fifty-eight pre- and post-treatment FDG PET scans of patients with head and neck squamous cell cancer to calculate five standard and seventeen new features at baseline and post-treatment. Cox survival regression was used to assess the predictive potential of each quantitative imaging feature on disease-free survival. Results Analysis showed that the post-treatment change of the average tracer uptake in the rim background region immediately adjacent to the tumor normalized by uptake in the liver represents a novel PET feature that is associated with disease-free survival (HR 1.95; 95% CI 1.27, 2.99) and has good discriminative performance (c index 0.791). Conclusion The reported findings define a promising new direction for quantitative imaging biomarker research in head and neck squamous cell cancer and highlight the potential role of new radiomics features in oncology decision making as part of precision medicine.
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Affiliation(s)
- Reinhard R. Beichel
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
- Department of Internal Medicine, The University of Iowa, Iowa City, United States of America
- * E-mail:
| | - Ethan J. Ulrich
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - Brian J. Smith
- Department of Biostatistics, The University of Iowa, Iowa City, United States of America
| | - Christian Bauer
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - Bartley Brown
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - Thomas Casavant
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, United States of America
| | - John J. Sunderland
- Department of Radiology, The University of Iowa, Iowa City, United States of America
| | - Michael M. Graham
- Department of Radiology, The University of Iowa, Iowa City, United States of America
| | - John M. Buatti
- Department of Radiation Oncology, The University of Iowa, Iowa City, United States of America
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Wang K, Wong TZ, Amdur RJ, Mendenhall WM, Sheets NC, Green R, Thorp BD, Patel SN, Hackman TG, Zanation AM, Weissler MC, Chera BS. Pitfalls of post-treatment PET after de-intensified chemoradiotherapy for HPV-associated oropharynx cancer: Secondary analysis of a phase 2 trial. Oral Oncol 2018; 78:108-113. [DOI: 10.1016/j.oraloncology.2018.01.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 11/16/2022]
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Nelissen C, Sherriff J, Jones T, Guest P, Colley S, Sanghera P, Hartley A. The Role of Positron Emission Tomography/Computed Tomography Imaging in Head and Neck Cancer after Radical Chemoradiotherapy: a Single Institution Experience. Clin Oncol (R Coll Radiol) 2017; 29:753-759. [PMID: 28780008 DOI: 10.1016/j.clon.2017.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 12/14/2022]
Abstract
AIMS Positron emission tomography/computed tomography (PET/CT) is used to restage head and neck cancer 3 months after chemoradiotherapy. The purpose of this study was to determine the negative predictive value (NPV) of a scan reported as having no abnormal uptake and the positive predictive values (PPV) for different maximum standardised uptake value (SUVmax) thresholds. MATERIALS AND METHODS Patients with squamous cell carcinoma of the oro-/hypopharynx/larynx (n = 206) were included. SUVmax and subsequent locoregional recurrence were documented. RESULTS The median SUVmax was 11.2 (range 4-33)/4.6 (range 2-30), respectively, in patients with/without definite primary site recurrence (P = 0.004). The median SUVmax was 4.4 (range 2.6-15.6)/3.1 (range 2.1-4.6), respectively, in patients with/without definite nodal recurrence (P = 0.003). The NPV for a scan reported as having no abnormal uptake was 92%. The PPV for the SUVmax thresholds 4, 6 and 8, respectively, were 53, 65 and 92% (primary site) and 93, 100 and 100% (nodes). CONCLUSIONS The NPV of PET/CT after chemoradiation is consistent with the literature and underlines the importance of PET/CT in restaging the primary site if salvage neck dissection is considered. The overall PPV of PET/CT remains low but is high for nodal SUVmax > 4. These data could be used to design risk-stratified follow-up schedules.
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Affiliation(s)
- C Nelissen
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK.
| | - J Sherriff
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - T Jones
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - P Guest
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - S Colley
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
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Predictive medicine: towards a multi-parametric imaging for a personal risk stratification. Eur J Nucl Med Mol Imaging 2017; 44:196-198. [PMID: 27678266 DOI: 10.1007/s00259-016-3522-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Bird T, Barrington S, Thavaraj S, Jeannon JP, Lyons A, Oakley R, Simo R, Lei M, Guerrero Urbano T. (18)F-FDG PET/CT to assess response and guide risk-stratified follow-up after chemoradiotherapy for oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2016; 43:1239-47. [PMID: 26707387 DOI: 10.1007/s00259-015-3290-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the use of (18)F-FDG PET/CT as the principal investigation to assess tumour response, to determine the need for further surgery and to guide follow-up following radical chemoradiotherapy for stage III/IV oropharyngeal squamous cell carcinoma (OPSCC). METHODS A retrospective analysis was undertaken in 146 patients treated at our centre with radical chemoradiotherapy for OPSCC and who had a PET/CT scan to assess response. According to the PET/CT findings, patients were divided into four groups and recommendations: (1) complete metabolic response (enter clinical follow-up); (2) low-level uptake only (follow-up PET/CT scan in 12 weeks); (3) residual uptake suspicious for residual disease (further investigation with or without neck dissection); and (4) new diagnosis of distant metastatic disease (palliative treatment options). RESULTS The initial PET/CT scan was performed at a median of 12.4 weeks (range 4.3 - 21.7 weeks) following treatment. Overall sensitivity and specificity rates were 92.0 % (74.0 - 99.0 %) and 85 % (77.5 - 90.9 %). Of the 146 patients, 90 (62 %) had a complete response and had estimated 3-year overall and disease-free survival rates of 91.9 % (85.6 - 98.2 %) and 85.6 % (78.0 - 93.2 %), respectively, 17 (12 %) had residual low-level uptake only (with two having confirmed residual disease on subsequent PET/CT, both surgically salvaged), 30 (21 %) had suspicious residual uptake (12 proceeded to neck dissection; true positive rate at surgery 33 %). HPV-positive patients with reassuring PET/CT findings had an estimated 3-year progression-free survival rate of 91.7 % (85.2 - 98.2 %), compared with 66.2 % (41.5 - 90.9 %) of HPV-negative patients. CONCLUSION A strategy of using PET/CT results alongside clinical examination to help select patients for salvage surgery appears successful. Despite a complete response on the 12-week PET/CT scan, HPV-negative patients have a significant risk of disease relapse in the following 2 years and further studies to assess whether surveillance imaging in this group could improve outcomes are warranted.
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Affiliation(s)
- Thomas Bird
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Sally Barrington
- PET Imaging Centre at St Thomas' Hospital, King's College, London, UK
| | - Selvam Thavaraj
- Head and Neck Pathology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jean-Pierre Jeannon
- Department of Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Lyons
- Department of Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Oakley
- Department of Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ricard Simo
- Department of Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mary Lei
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Potential Role of PET/MRI for Imaging Metastatic Lymph Nodes in Head and Neck Cancer. AJR Am J Roentgenol 2016; 207:248-56. [PMID: 27163282 DOI: 10.2214/ajr.16.16265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This article explores recent developments in PET and MRI, separately or combined, for assessing metastatic lymph nodes in patients with head and neck cancer. CONCLUSION The synergistic role of PET and MRI for imaging metastatic lymph nodes has not been fully explored. To facilitate the understanding of the areas that need further investigation, we discuss potential mechanisms and evidence reported so far, as well as future directions and challenges for continued development and clinical research.
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Qualitative interpretation of PET scans using a Likert scale to assess neck node response to radiotherapy in head and neck cancer. Eur J Nucl Med Mol Imaging 2015; 43:609-16. [DOI: 10.1007/s00259-015-3194-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
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Differentiation of benign from malignant cervical lymph nodes in patients with head and neck cancer using PET/CT imaging. Clin Imaging 2015; 40:101-5. [PMID: 26454617 DOI: 10.1016/j.clinimag.2015.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/16/2015] [Accepted: 09/01/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE To differentiate malignant from benign cervical lymph nodes in patients with head/neck cancer. METHODS In this retrospective study, 39 patients with primary head/neck cancer who underwent Positron Emission Tomography (PET)/Computerized Tomography (CT) and image-guided lymph node biopsy were included. RESULTS Overall, 23 (59%) patients had biopsy-proven malignant cervical lymphadenopathy. Malignant lymph nodes had higher maximum standardized uptake (SUV-max) value (P<.001) and short-axis diameter (P=.015) compared to benign nodes. An SUV-max of ≥2.5 was 100% sensitive, and an SUV-max ≥5.5 was 100% specific for malignant lymphadenopathy. CONCLUSION The PET/CT SUV-max value can help with differentiation of malignant cervical lymph nodes in patients with head/neck cancer.
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