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Vartak A, Malhotra M, Jaiswal P, Talwar R, Tyagi A, Kishore B. Role of 18F-FDG PET/CT in Guiding Surgical Management of Clinically Node Negative Neck (cN0) in Carcinoma Oral Cavity. Indian J Otolaryngol Head Neck Surg 2023; 75:1799-1805. [PMID: 37636652 PMCID: PMC10447354 DOI: 10.1007/s12070-023-03744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/27/2023] [Indexed: 08/29/2023] Open
Abstract
Conventional staging paradigm with clinical examination or imaging invariably leads to underestimation of occult metastatic neck disease in oral cavity carcinoma. The advantage of 18F-FDG PET/CT is in its ability to identify lymph nodes without morphological changes yet harboring occult metastases. We present findings of our study to evaluate diagnostic accuracy of 18F-FDG PET/CT, in detecting occult cervical lymph node metastasis in carcinoma oral cavity. In a single institution prospective study, 51 consecutive patients with histologically proven (cT1/T2) oral cavity carcinoma and clinically node negative neck (cNo), underwent 18F-FDG PET/CT before elective neck dissection of 58 neck sides. 18F-FDG PET/CT findings were compared with histopathology of dissected nodes, to calculate diagnostic accuracy. 18F-FDG PET/CT correctly characterized the occult lymph node metastasis status (true positive + true negative) in 51 of 58 neck sides, yielding diagnostic accuracy of 87.93%. Sensitivity of 18F-FDG PET/CT was 90% and specificity was 87.5%. While a positive 18F-FDG PET/CT accurately predicted the disease in only 60% (positive predictive value), a negative 18F-FDG PET/CT reasonably ruled out occult metastases in 97.67% (negative predictive value). If a decision regarding the need for neck dissection had been based solely on 18F-FDG PET/CT, the number of neck dissections would have been reduced by 74.13%. Based on diagnostic accuracy and high negative predictive value, incorporating 18F-FDG PET/CT in preoperative staging paradigm of cT1/T2 carcinoma oral cavity will guide in selection of patients in which cN0 neck can be safely observed.
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Affiliation(s)
- Anushree Vartak
- Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cantt, New Delhi, 110010 India
| | - Munish Malhotra
- Department of Surgical Oncology, INHS Asvini, Mumbai, 40005 India
| | - Pradeep Jaiswal
- Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cantt, New Delhi, 110010 India
| | - Rajnish Talwar
- Department of Surgical Oncology, Fortis Mohali, Sahibzada Ajit Singh Nagar, Punjab 160062 India
| | - Arvind Tyagi
- Department of Surgical Oncology, Yashoda Super Speciality Hospital and Cancer Institute, Ghaziabad, Uttar Pradesh 201002 India
| | - Brij Kishore
- Department of Nuclear Medicine, INHS Asvini, Mumbai, 40005 India
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Mütevelizade G, Sezgin C, Parlak Y, Gümüşer G, Sayit E. Contribution of Open Mouth Technique in 18F-FDG PET/CT Imaging in Patients with Malignant Lip Neoplasm. Mol Imaging Radionucl Ther 2022; 31:172-178. [PMID: 36268853 PMCID: PMC9586000 DOI: 10.4274/mirt.galenos.2022.79836] [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] [Indexed: 12/24/2022] Open
Abstract
Objectives: 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) plays an important role in evaluating head and neck cancers. However, localization and size evaluation in this region can be rough due to the multitude of the anatomic structures and physiologic uptakes. The aim of this study was to evaluate malignant lip lesions with the contribution of open mouth (OM) imaging technique at PET/CT. Methods: Fifty-six patients with malignant lip neoplasm underwent 18F-FDG PET/CT imaging. Each patient was imaged twice as whole-body PET/CT with routine closed mouth (CM) position; and OM head and neck image, standardized with a special device. Lesion maximum standard uptake value (SUVmax), localization, size, and involvement of lymph nodes were evaluated. Results: Lesion localization was correctly detected in 100% of the OM images. Lesion size in PET/CT was compared with clinical, radiological (magnetic resonance imaging and CT) and/or histopathological results and the size measurement was coherent at 47.1% and 95.6% for CM and OM images, respectively. It was observed that OM acquisition did not contribute additionally in detecting regional lymph node metastasis. Forty-one PET/CT scans with CT artifacts due to dental amalgams were evaluated and 46.3% dimensional and 53.7% localization errors were detected in the CM position. There was no statistically significant difference between OM and CM SUVmax (p>0.05). Conclusion: We concluded that additional OM head and neck imaging is useful and necessary to accurately determine the localization and size of the tumor, thus enhancing the value of PET/CT in staging, treatment response assessment, and restaging of patients with malignant lip cancer with or without dental amalgam
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Affiliation(s)
- Gözde Mütevelizade
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| | - Ceren Sezgin
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| | - Yasemin Parlak
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| | - Gül Gümüşer
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| | - Elvan Sayit
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
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3
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Ghantous Y, Omar M, Broner EC, Agrawal N, Pearson AT, Rosenberg AJ, Mishra V, Singh A, Abu El-naaj I, Savage PA, Sidransky D, Marchionni L, Izumchenko E. A robust and interpretable gene signature for predicting the lymph node status of primary T1/T2 oral cavity squamous cell carcinoma. Int J Cancer 2022; 150:450-460. [PMID: 34569064 PMCID: PMC8760163 DOI: 10.1002/ijc.33828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/31/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
Oral cavity squamous cell carcinoma (OSCC) affects more than 30 000 individuals in the United States annually, with smoking and alcohol consumption being the main risk factors. Management of early-stage tumors usually includes surgical resection followed by postoperative radiotherapy in certain cases. The cervical lymph nodes (LNs) are the most common site for local metastasis, and elective neck dissection is usually performed if the primary tumor thickness is greater than 3.5 mm. However, postoperative histological examination often reveals that many patients with early-stage disease are negative for neck nodal metastasis, posing a pressing need for improved risk stratification to either avoid overtreatment or prevent the disease progression. To this end, we aimed to identify a primary tumor gene signature that can accurately predict cervical LN metastasis in patients with early-stage OSCC. Using gene expression profiles from 189 samples, we trained K-top scoring pairs models and identified six gene pairs that can distinguish primary tumors with nodal metastasis from those without metastasis. The signature was further validated on an independent cohort of 35 patients using real-time polymerase chain reaction (PCR) in which it achieved an area under the receiver operating characteristic (ROC) curve and accuracy of 90% and 91%, respectively. These results indicate that such signature holds promise as a quick and cost effective method for detecting patients at high risk of developing cervical LN metastasis, and may be potentially used to guide the neck treatment regimen in early-stage OSCC.
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Affiliation(s)
- Yasmin Ghantous
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.4 Department of Medicine, University of Chicago, Chicago, IL, USA.,Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Israel
| | - Mohamed Omar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Esther Channah Broner
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.4 Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nishant Agrawal
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Alexander T. Pearson
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Ari J. Rosenberg
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Vasudha Mishra
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Alka Singh
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Imad Abu El-naaj
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Israel
| | - Peter A. Savage
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - David Sidransky
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.4 Department of Medicine, University of Chicago, Chicago, IL, USA.,Corresponding Authors: Evgeny Izumchenko, Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA. , Luigi Marchionni, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA. , and David Sidransky, Departments of Otolaryngology and Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Luigi Marchionni
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.,Corresponding Authors: Evgeny Izumchenko, Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA. , Luigi Marchionni, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA. , and David Sidransky, Departments of Otolaryngology and Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA.,Corresponding Authors: Evgeny Izumchenko, Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA. , Luigi Marchionni, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA. , and David Sidransky, Departments of Otolaryngology and Oncology, Johns Hopkins University, Baltimore, MD, USA
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4
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Tsetsos N, Poutoglidis A, Arsos G, Tsentemeidou A, Kilmpasanis A, Katsampoukas D, Fyrmpas G. 18F-FDG-PET/CT interpretation pitfalls in patients with head and neck cancer. Am J Otolaryngol 2022; 43:103209. [PMID: 34536919 DOI: 10.1016/j.amjoto.2021.103209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/05/2021] [Indexed: 11/01/2022]
Abstract
AIM The aim of the present study is to raise awareness of ENT Surgeons on the limitations of 18F-FDG PET/CT in head and neck cancer by presenting illustrative cases from our department archives. MATERIALS AND METHODS A retrospective chart review was conducted for all patients with head and neck cancer treated in our ENT department from 2015 to 2020. Cases with various interpretation pitfalls due to false-positive and false-negative PET/CT results that lead to diagnostic dilemmas and treatment delays either in their pre-therapeutic work-up or in their post-therapeutic monitoring were included. RESULTS Five cases of various image interpretation pitfalls (3 false negative and 2 false positive cases) were identified and are presented in detail. CONCLUSIONS Although 18F-FDG PET/CT has gained in popularity and improved head and neck cancer management, clinicians should be aware of its limitations. The combination of 18F-FDG PET/CT with other imaging modalities can reduce the number of interpretation pitfalls but by no means will substitute sound clinical judgement.
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Duraj T, Carrión-Navarro J, Seyfried TN, García-Romero N, Ayuso-Sacido A. Metabolic therapy and bioenergetic analysis: The missing piece of the puzzle. Mol Metab 2021; 54:101389. [PMID: 34749013 PMCID: PMC8637646 DOI: 10.1016/j.molmet.2021.101389] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Aberrant metabolism is recognized as a hallmark of cancer, a pillar necessary for cellular proliferation. Regarding bioenergetics (ATP generation), most cancers display a preference not only toward aerobic glycolysis ("Warburg effect") and glutaminolysis (mitochondrial substrate level-phosphorylation) but also toward other metabolites such as lactate, pyruvate, and fat-derived sources. These secondary metabolites can assist in proliferation but cannot fully cover ATP demands. SCOPE OF REVIEW The concept of a static metabolic profile is challenged by instances of heterogeneity and flexibility to meet fuel/anaplerotic demands. Although metabolic therapies are a promising tool to improve therapeutic outcomes, either via pharmacological targets or press-pulse interventions, metabolic plasticity is rarely considered. Lack of bioenergetic analysis in vitro and patient-derived models is hindering translational potential. Here, we review the bioenergetics of cancer and propose a simple analysis of major metabolic pathways, encompassing both affordable and advanced techniques. A comprehensive compendium of Seahorse XF bioenergetic measurements is presented for the first time. MAJOR CONCLUSIONS Standardization of principal readouts might help researchers to collect a complete metabolic picture of cancer using the most appropriate methods depending on the sample of interest.
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Affiliation(s)
- Tomás Duraj
- Faculty of Medicine, Institute for Applied Molecular Medicine (IMMA), CEU San Pablo University, 28668, Madrid, Spain.
| | - Josefa Carrión-Navarro
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223, Madrid, Spain; Brain Tumor Laboratory, Fundación Vithas, Grupo Hospitales Vithas, 28043, Madrid, Spain.
| | - Thomas N Seyfried
- Biology Department, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.
| | - Noemí García-Romero
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223, Madrid, Spain; Brain Tumor Laboratory, Fundación Vithas, Grupo Hospitales Vithas, 28043, Madrid, Spain.
| | - Angel Ayuso-Sacido
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, 28223, Madrid, Spain; Brain Tumor Laboratory, Fundación Vithas, Grupo Hospitales Vithas, 28043, Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, 28223, Madrid, Spain.
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6
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Linz C, Brands RC, Herterich T, Hartmann S, Müller-Richter U, Kübler AC, Haug L, Kertels O, Bley TA, Dierks A, Buck AK, Lapa C, Brumberg J. Accuracy of 18-F Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Imaging in Primary Staging of Squamous Cell Carcinoma of the Oral Cavity. JAMA Netw Open 2021; 4:e217083. [PMID: 33881529 PMCID: PMC8060833 DOI: 10.1001/jamanetworkopen.2021.7083] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Squamous cell carcinoma (SCC) of the oral cavity is one of the most common tumor entities worldwide. Precise initial staging is necessary to determine a diagnosis, treatment, and prognosis. OBJECTIVE To examine the diagnostic accuracy of preoperative 18-F fluorodeoxyglucose (FDG) positron emission tomographic/computed tomographic (PET/CT) imaging in detecting cervical lymph node metastases. DESIGN, SETTING, AND PARTICIPANTS This prospective diagnostic study was performed at a single tertiary reference center between June 1, 2013, and January 31, 2016. Data were analyzed from April 7, 2018, through May 31, 2019. Observers of the FDG PET/CT imaging were blinded to patients' tumor stage. A total of 150 treatment-naive patients with clinical suspicion of SCC of the oral cavity were enrolled. EXPOSURES All patients underwent FDG PET/CT imaging before local tumor resection with selective or complete neck dissection. MAIN OUTCOMES AND MEASURES The accuracy of FDG PET/CT in localizing primary tumor, lymph node, and distant metastases was tested. Histopathologic characteristics of the tissue samples served as the standard of reference. RESULTS Of the 150 patients enrolled, 135 patients (74 [54.8%] men) with a median age of 63 years (range, 23-88 years) met the inclusion criteria (histopathologically confirmed primary SCC of the oral cavity/level-based histopathologic assessment of the resected lymph nodes). Thirty-six patients (26.7%) in the study cohort had neck metastases. Use of FDG PET/CT detected cervical lymph node metastasis with 83.3% sensitivity (95% CI, 71.2%-95.5%) and 84.8% specificity (95% CI, 77.8%-91.9%) and had a negative predictive value of 93.3% (95% CI, 88.2%-98.5%). The specificity was higher than for contrast-enhanced cervical CT imaging (67.0%; 95% CI, 57.4%-76.7%; P < .01) and cervical magnetic resonance imaging (62.6%; 95% CI, 52.7%-72.6%; P < .001). Ipsilateral lymph node metastasis in left- or right-sided primary tumor sites was detected with 78.6% sensitivity (95% CI, 63.4%-93.8%) and 83.1% specificity (95% CI, 75.1%-91.2%), and contralateral metastatic involvement was detected with 66.7% sensitivity (95% CI, 28.9%-100.0%) and 98.6% specificity (95% CI, 95.9%-100.0%). No distant metastases were observed. CONCLUSIONS AND RELEVANCE In this study, FDG PET/CT imaging had a high negative predictive value in detecting cervical lymph node metastasis in patients with newly diagnosed, treatment-naive SCC of the oral cavity. Routine clinical use of FDG PET/CT might lead to a substantial reduction of treatment-related morbidity in most patients.
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Affiliation(s)
- Christian Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Roman C. Brands
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Theresia Herterich
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Urs Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Alexander C. Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Lukas Haug
- Department of Pathology, University of Würzburg, Würzburg, Germany
| | - Olivia Kertels
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten A. Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Alexander Dierks
- Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas K. Buck
- Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
- Nuclear Medicine, Medical Faculty University of Augsburg, Augsburg, Germany
| | - Joachim Brumberg
- Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
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Crimì F, Borsetto D, Stramare R, Di Carlo R, Emauelli E, Nicolai P, Lacognata C, Zucchetta P, Oliveri G, Merola A, Bodanza V, Albertoni L, Campi C, Cecchin D. [ 18F]FDG PET/MRI versus contrast-enhanced MRI in detecting regional HNSCC metastases. Ann Nucl Med 2021; 35:260-269. [PMID: 33454923 DOI: 10.1007/s12149-020-01565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard. METHODS We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard. RESULTS Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%). CONCLUSIONS Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
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Affiliation(s)
- Filippo Crimì
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Daniele Borsetto
- Guy's and St Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
| | - Roberto Stramare
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Roberto Di Carlo
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Enzo Emauelli
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Piero Nicolai
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | | | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Giulia Oliveri
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Arcangelo Merola
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Valentina Bodanza
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Laura Albertoni
- Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Cristina Campi
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
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Lee J, Emmett L, Tang R, Ho B, Earls P, Matthews T, Gallagher R. Prospective evaluation of the impact of human papilloma virus status and small node size on the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for primary head and neck squamous cell carcinoma. ANZ J Surg 2020; 90:1396-1401. [PMID: 32564498 DOI: 10.1111/ans.16093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is well validated in the staging of pre-treatment head and neck squamous cell carcinoma (HNSCC), although the impact of human papilloma virus (HPV) status and node size on accuracy remains unclear. The aim of this study was to assess the diagnostic accuracy of PET/CT based on HPV status and node size and determine the effects of maximum standardized uptake value thresholds on sensitivity, specificity and positive predictive value. METHODS A total of 38 patients with primary HNSCC were recruited. All patients underwent primary tumour resection and cervical node dissection following FDG-PET/CT. RESULTS A total of 38 patients including 68 dissected necks, representing 353 nodal levels and a total of 2701 lymph nodes were included. Histopathological analysis revealed lymph node metastases in 4.3% (116/2701) of dissected lymph nodes. Forty-four percent of patients had HPV-positive tumours. Sixty-four percent of involved lymph nodes were <1 cm. The sensitivity and specificity for HPV-positive nodes were 67.2% and 99.3% versus 35.6% and 98.2% in HPV-negative nodes, respectively (P < 0.001). Mean maximum standardized uptake value in HPV-positive nodes was 6.3 versus 3.5 in HPV-negative nodes (P < 0.001). Sensitivity and specificity were 30.7% and 99.2% in <1 cm nodes versus 90.2% and 84.8% in ≥1 cm nodes, respectively (P < 0.001). CONCLUSION FDG-PET/CT has significantly higher diagnostic accuracy in determining nodal metastases in HPV-positive HNSCC versus HPV-negative disease. Accuracy was lower in <1 versus ≥1 cm nodes.
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Affiliation(s)
- Jonathan Lee
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Reuben Tang
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Bao Ho
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Peter Earls
- Department of Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Tim Matthews
- Department of Otolaryngology-Head and Neck Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Richard Gallagher
- Department of Otolaryngology-Head and Neck Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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LeRose CC, Boura J, Ramirez CA. Investigating the Reliability of Fluorodeoxyglucose 18 Positive Emission Tomography-Computed Tomography Detection of Regional Lymph Node Metastasis in Head and Neck Malignancy. J Oral Maxillofac Surg 2020; 78:1631-1638. [PMID: 32502386 DOI: 10.1016/j.joms.2020.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/04/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study investigated whether fluorodeoxyglucose 18 positive emission tomography (PET)-computed tomography (CT) may be relied on to direct surgical management of the neck in patients with head and neck cancer by assessing the accuracy with which it is able to detect the presence and location of regional lymph node metastasis compared with histologic examination. PATIENTS AND METHODS This retrospective study reviewed consecutive cases of head and neck cancer in which patients received a PET-CT scan within 3 weeks of undergoing a neck dissection performed by the Ascension Macomb-Oakland oral and maxillofacial surgery residency program from July 2013 through July 2018. Neck dissection specimens were orientated by the surgeon according to neck level and submitted for histopathologic examination. These histopathologic results served as the standard reference with which preoperative PET-CT results were compared. RESULTS A total of 156 cases were reviewed in this study, 84 of which were included for data analysis. PET-CT exhibited an overall sensitivity of 68.9% and specificity of 61.5% in detecting regional lymph node metastasis (positive predictive value, 67.4%; negative predictive value, 63.2%). PET-CT showed a sensitivity of 71.4% and specificity of 75.0% for 34 cases involving pT1 lesions (positive predictive value, 66.7%; negative predictive value, 79.0%). Of 25 true-positive PET-CT scans correctly correlating with pN+ neck specimens, 16 (64%) were inaccurate in identifying the proper levels of metastatic disease identified by histopathologic assessment. These scans flagged 44 neck levels positive for disease, 18 (41%) of which were histologically proven false positive. Of the 48 neck levels in these cases confirmed positive for metastasis by histopathologic assessment, 22 (46%) failed detection by what would otherwise be considered true-positive PET-CT scans. CONCLUSIONS The results of this study suggest that PET-CT is unable to adequately detect the overall presence or precise location of metastatic disease in the neck and so cannot be relied on to direct surgical management of the neck in patients with head and neck cancer.
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Affiliation(s)
- Claude Charles LeRose
- Chief Resident, Department of Oral and Maxillofacial Surgery, Ascension Macomb-Oakland Hospital, Warren, MI
| | - Judith Boura
- Biostatistician and Director of Research, Department of Graduate Medical Education, Ascension Macomb-Oakland Hospital, Warren, MI
| | - Carlos Antonio Ramirez
- Fellowship Director, Head and Neck Oncology/Microvascular Surgery, and Chief and Residency Program Director, Department of Oral and Maxillofacial Surgery, Ascension St. John Hospital, Detroit, MI.
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10
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Niu L, Zheng D, Wang D, Zhang J, Fei J, Guo C. Accuracy of 18 F-FDG PET/CT in Detection of Neck Metastases of Oral Squamous Cell Carcinoma in Patients Without Large Palpable Lymph Nodes. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:418-426. [PMID: 32057754 DOI: 10.1016/j.oooo.2019.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/06/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To measure the efficacy of positron emission tomography/computed tomography (PET/CT) in the diagnosis of neck metastases of oral squamous cell carcinoma (OSCC) in patients without enlarged lymph nodes and to determine the threshold of maximum standardized uptake values (SUVmax) in diagnosis. STUDY DESIGN In total, 78 OSCC patients without large palpable lymph nodes were included. PET/CT findings were compared with histopathologic neck status. RESULTS Neck dissection was performed in 78 patients with 98 neck sides, and 31 neck sides harbored metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 83.9%, 73.1%, 76.5%, 59.1%, and 90.7%, respectively. The area under the curve in receiver operating characteristic analysis was 0.76, which indicated that SUVmax of lymph nodes was useful in diagnosis of pathologic neck status. The threshold SUVmax was 2.21, which was the best diagnosis threshold of neck metastasis. CONCLUSIONS PET/CT is valuable in diagnosis of neck status. The probability of neck metastasis increased with increasing SUVmax values, but the threshold SUVmax should not be the sole criterion for determining the presence of neck metastases. Fluorodeoxyglucose PET/CT is recommended for evaluation of neck status in OSCC patients without large palpable lymph nodes.
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Affiliation(s)
- Lixuan Niu
- Fourth Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - Dong Zheng
- Department of Radiology, 306 Hospital of People's Liberation Army, Beijing, China
| | - Diancan Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jianyun Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jun Fei
- Department of Radiology, 306 Hospital of People's Liberation Army, Beijing, China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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11
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Heft Neal ME, Brennan J, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, McLean SA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Predictors and Prevalence of Nodal Disease in Salvage Oropharyngectomy. Ann Surg Oncol 2019; 27:451-457. [PMID: 31538289 DOI: 10.1245/s10434-019-07841-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with recurrent oropharyngeal cancer often require extensive salvage surgery. For patients with clinically N0 necks, the indication for concurrent neck dissection remains unclear. This study aimed to determine predictors, prevalence, and distribution of nodal disease in patients treated with salvage oropharyngectomy. METHODS In a case series with data collection at a single tertiary academic National Cancer Institute (NCI)-designated comprehensive cancer center, this study analyzed patients treated with prior radiation or chemoradiation who had persistent, recurrent, or second primary squamous cell carcinoma of the oropharynx requiring oropharyngeal resection between 1998 and 2017 (n = 95). Clinical and oncologic characteristics and treatment outcomes were collected, and statistical analyses were performed. RESULTS The overall rate of nodal positivity was 21% (24/95), and the rate of occult nodal disease was 6% (4/65). Ipsilateral and contralateral level 2 were the most common areas harboring positive nodes. Bivariate analysis showed female sex (p = 0.01), initial overall stage (p = 0.02), and N status (p = 0.03), as well as recurrent overall and T stage (p = 0.05) to be predictors of nodal disease. In the multivariate analysis, recurrent T stage continued to be significantly predictive of pathologic nodal disease. Both computed tomography (CT) and positron emission tomography-CT were moderately accurate in predicting nodal disease in the salvage setting (area under the curve, 0.79 and 0.80, respectively). CONCLUSION Occult nodal disease is observed in few patients undergoing salvage oropharyngeal resection. This study identified factors predictive of nodal disease in patients undergoing salvage oropharyngectomy and appropriate diagnostic tests in this setting.
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Affiliation(s)
- M E Heft Neal
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J Brennan
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J C Brenner
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - A G Shuman
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S B Chinn
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - C L Stucken
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - K M Malloy
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J S Moyer
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - K A Casper
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S A McLean
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M E P Prince
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - C R Bradford
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - G T Wolf
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - D B Chepeha
- Head and Neck Surgical Oncology and Reconstructive Microsurgery, Department of Otolaryngology, Department of Surgical Oncology, University of Toronto, Toronto, ON, USA
| | - A J Rosko
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M E Spector
- Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
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12
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McMullen CP, Garneau J, Weimar E, Ali S, Farinhas JM, Yu E, Som PM, Sarta C, Goldstein DP, Su S, Xu W, Smith RV, Miles B, de Almeida JR. Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection. Oral Oncol 2019; 93:96-100. [DOI: 10.1016/j.oraloncology.2019.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/18/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022]
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13
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Kim SJ, Pak K, Kim K. Diagnostic accuracy of F-18 FDG PET or PET/CT for detection of lymph node metastasis in clinically node negative head and neck cancer patients; A systematic review and meta-analysis. Am J Otolaryngol 2019; 40:297-305. [PMID: 30473166 DOI: 10.1016/j.amjoto.2018.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of the current study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) for the detection of cervical lymph node (LN) metastasis in clinically node negative head and neck squamous cell cancer (cN0 HNSCC) patients through a systematic review and meta-analysis. METHODS The PubMed and EMBASE database, from the earliest available date of indexing through April 30, 2018, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT for the detection of LN metastasis in cN0 HNSCC patients. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic (SROC) curves. RESULTS Across 18 studies (1044 patients), the pooled sensitivity for F-18 FDG PET or PET/CT for the detection of LN metastasis was 0.58 and a pooled specificity of 0.87 for patient based analysis. Neck side based analysis showed the pooled sensitivity of 0.67 and a pooled specificity of 0.85. Level based study demonstrated the pooled sensitivity of 0.53 and a pooled specificity of 0.97 (95% CI; 0.95-0.98). In meta-regression analysis, no definite variable was the source of the study heterogeneity. CONCLUSION The current meta-analysis showed the low sensitivity and moderate specificity of F-18 FDG PET/CT for the detection of cervical LN metastasis in cN0 HNSCC patients. Level based analysis of F-18 FDG PET or PET/CT has a high specificity and NPV for the detection of cervical metastatic LN detection.
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14
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Lowe VJ, Duan F, Subramaniam RM, Sicks JD, Romanoff J, Bartel T, Yu JQM, Nussenbaum B, Richmon J, Arnold CD, Cognetti D, Stack BC. Multicenter Trial of [ 18F]fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging of Head and Neck Cancer and Negative Predictive Value and Surgical Impact in the N0 Neck: Results From ACRIN 6685. J Clin Oncol 2019; 37:1704-1712. [PMID: 30768363 DOI: 10.1200/jco.18.01182] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The objective of this study was to determine the negative predictive value (NPV) of positron emission tomography (PET)/computed tomography (CT) for the clinically N0 neck on the basis of neck dissection. METHODS Participants with newly diagnosed, first-time, head and neck squamous cell carcinoma (HNSCC) and at least one clinically N0 neck side for which dissection was planned were included. A total of 287 participants were prospectively enrolled from 23 American College of Radiology Imaging Network-qualified institutions. PET/CT was compared with findings at neck dissection. RESULTS PET/CT scans and pathology findings were available for 270 N0 neck sides from 212 participants. For visual assessment, the NPV specific to the clinical-N0 sides was 0.868 (95% CI, 0.803 to 0.925). For dichotomized maximum standardized uptake value, the NPVs specific to the nodal basins were 0.940 (95% CI, 0.928 to 0.952) and 0.937 (95% CI, 0.925 to 0.949) at prespecified cutoffs of 2.5 and 3.5, respectively. The optimal cutoff maximum standardized uptake value was determined to be 1.8, with an NPV of 0.942 (95% CI, 0.930 to 0.953). The PET/CT-informed surgical treatment plan was changed in 51 of 237 participants (22%) compared with the PET/CT-blinded surgical plan. In 34 participants (14%), this led to planned dissection of additional nodal levels. In 12 participants (5%), this led to fewer planned dissected nodal levels. Negative PET/CT scans in N0 necks was true negative in 87% and false negative in 13%. CONCLUSION [18F]fluorodeoxyglucose-PET/CT has high NPV for the N0 neck in T2 to T4 HNSCC. The surgical treatment plans on the basis of PET/CT findings may be changed in approximately 22% of this group. These findings suggest that [18F]fluorodeoxyglucose-PET/CT may assist the clinician in deciding on the best therapy for the clinically N0 neck in HNSCC. Well-designed clinical trials should be performed to test the outcome of omitting neck dissection by using PET/CT.
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Affiliation(s)
| | - Fenghai Duan
- 2 Brown University School of Public Health, Providence, RI
| | | | - JoRean D Sicks
- 2 Brown University School of Public Health, Providence, RI
| | | | | | | | | | | | | | - David Cognetti
- 9 Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Brendan C Stack
- 10 University of Arkansas for Medical Sciences, Little Rock, AR
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15
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Kirchner J, Schaarschmidt BM, Sauerwein W, Deuschl C, Arweiler-Harbeck D, Holtmann L, Stebner V, Umutlu L, Antoch G, Ruhlmann V. 18 F-FDG PET/MRI vs MRI in patients with recurrent adenoid cystic carcinoma. Head Neck 2018; 41:170-176. [PMID: 30548894 DOI: 10.1002/hed.25485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/27/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate and compare the diagnostic potential of 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18 FDG-PET/MRI) and MRI for recurrence diagnostics after primary therapy in patients with adenoid cystic carcinoma (ACC). METHODS A total of 32 dedicated head and neck 18 F-FDG PET/MRI datasets were included in this analysis. MRI and 18 F-FDG PET/MRI datasets were analyzed in separate sessions by two readers for tumor recurrence or metastases. RESULTS Lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 96%, 84%, 90%, 93%, and 91% for 18 F-FDG PET/MRI and 77%, 94%, 95%, 73%, and 84% for MRI, resulting in a significantly higher diagnostic accuracy of 18 F-FDG PET/MRI compared to MRI (P < .005). CONCLUSION 18 F-FDG PET/MRI is superior to MRI in detecting local recurrence and metastases in patients with ACC of the head and neck. Especially concerning its negative predictive value, 18 F-FDG PET/MRI outperforms MRI.
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Affiliation(s)
- Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Wolfgang Sauerwein
- Department of Radiation Oncology, University of Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Laura Holtmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vanessa Stebner
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Verena Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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16
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Naros A, Weise H, Krimmel M, Reinert S. Isolated gluteal metastasis 3 years after sufficiently treated oral squamous cell carcinoma: Case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e51-e55. [PMID: 30249534 DOI: 10.1016/j.oooo.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/15/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
Metastases from oral squamous cell carcinoma usually occur in the cervical lymph nodes. Distant skeletal muscle metastases are exceedingly rare and have been reported only in sporadic cases. A 70-year-old male patient was diagnosed with nonmetastatic oral squamous cell carcinoma (pT4a, N0, M0). The patient underwent successful surgical treatment involving tumor resection and selective neck dissection of both sides, including adjuvant radiotherapy. After 3 years of uneventful course, with no clinical or radiographic evidence for local recurrence or metastasis, an isolated distant metastasis in the gluteal muscles was diagnosed. The patient died 7 months after diagnosis despite further surgical resection and adjuvant chemotherapy. Distant metastases are mostly accompanied by systemic spread of tumor cells. Thus, the prognosis is generally very poor. The therapeutic concept of surgical tumor resection and adjuvant chemotherapy failed to significantly improve the patient's prognosis in the present case.
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Affiliation(s)
- Andreas Naros
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany.
| | - Hannes Weise
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
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17
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Mazzawi E, El-naaj IA, Ghantous Y, Balan S, Sabo E, Rachmiel A, Leiser Y. Clinical significance of preoperative imaging in oral squamous cell carcinoma compared with lymph node status: a comparative retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:423-430. [DOI: 10.1016/j.oooo.2017.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/12/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022]
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18
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Gage KL, Thomas K, Jeong D, Stallworth DG, Arrington JA. Multimodal Imaging of Head and Neck Squamous Cell Carcinoma. Cancer Control 2018; 24:172-179. [DOI: 10.1177/107327481702400209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kenneth L. Gage
- Diagnostic Imaging and Interventional Radiology Program,
University of South Florida College of Medicine, Tampa, Florida
| | - Kerry Thomas
- Diagnostic Imaging and Interventional Radiology Program,
University of South Florida College of Medicine, Tampa, Florida
| | - Daniel Jeong
- Diagnostic Imaging and Interventional Radiology Program,
University of South Florida College of Medicine, Tampa, Florida
| | - Dexter G. Stallworth
- Diagnostic Imaging and Interventional Radiology Program,
University of South Florida College of Medicine, Tampa, Florida
| | - John A. Arrington
- H. Lee Moffitt Cancer Center & Research Institute, and the Departments of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Florida
- Radiology, University of South Florida College of Medicine,
Tampa, Florida
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19
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Gvetadze SR, Xiong P, Li J, Lv M, Li J, Yang X, Ilkaev KD, Sun J. Contrast-enhanced ultrasound for diagnosis of an enlarged cervical lymph node in a patient with oropharyngeal cancer: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:495-499. [DOI: 10.1016/j.oooo.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 12/27/2022]
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20
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Gvetadze SR, Lv M, Ilkaev KD, Xiong P, Li J, Yang X, Sun J. [Imaging diagnostic methods for identification of sentinel lymph nodes in patients with early squamous cell carcinoma of the oral cavity mucosa: a literature review]. STOMATOLOGII︠A︡ 2017; 96:69-73. [PMID: 29072651 DOI: 10.17116/stomat201796569-73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The paper describes properties of clinical visualization approaches which are applied for detection of sentinel lymph nodes in patients suffering from oral cavity squamous cell cancer. Diagnostic efficiency results and technological features of different imaging techniques are discussed.
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Affiliation(s)
- S R Gvetadze
- Department of Oral Maxillofacial - Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China; Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M Lv
- Department of Oral Maxillofacial - Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - K D Ilkaev
- Department of head and neck tumors, upper gastro-respiratory tract tumors, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - P Xiong
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - J Li
- Department of Oral Maxillofacial - Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Yang
- Department of Oral Maxillofacial - Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - J Sun
- Department of Oral Maxillofacial - Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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21
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Cho JK, Ow TJ, Lee AY, Smith RV, Schlecht NF, Schiff BA, Tassler AB, Lin J, Moadel RM, Valdivia A, Abraham T, Gulko E, Neimark M, Ustun B, Bello JA, Shifteh K. Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 157:439-447. [PMID: 28608737 DOI: 10.1177/0194599817703927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design Case series with chart review. Setting Montefiore Medical Center, Bronx, New York. Subjects and Methods Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT ( P = .056, P = .001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT ( P = .014, P = .024). No significant difference was found in overall accuracy ( P = .33, P = .88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.
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Affiliation(s)
- Joshua K Cho
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew Y Lee
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Richard V Smith
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Nicolas F Schlecht
- 1 Albert Einstein College of Medicine, Bronx, New York, USA.,3 Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bradley A Schiff
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew B Tassler
- 4 Weill Cornell Medical College, Department of Otolaryngology-Head and Neck Surgery, New York, New York, USA
| | - Juan Lin
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Renee M Moadel
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Ana Valdivia
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Tony Abraham
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Edwin Gulko
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Matthew Neimark
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Berrin Ustun
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Jacqueline A Bello
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Keivan Shifteh
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
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22
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Rosko A, Birkeland A, Shuman A, Prince M, Bradford C, Wolf G, Worden F, Eisbruch A, Srinivasan A, Wong KK, Spector ME. Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer. Head Neck 2017; 39:980-987. [PMID: 28236331 DOI: 10.1002/hed.24719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 11/30/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the predictive value of positron emission tomography (PET)-CT in identifying occult nodal metastasis in clinically and radiographically N0 patients with recurrent laryngeal cancer undergoing salvage laryngectomy. METHODS Retrospective review of 46 clinically and radiographically N0 patients with recurrent laryngeal cancer who underwent a PET-CT examination before salvage laryngectomy with neck dissection from January 1, 2002, to December 31, 2014, was performed. RESULTS Two patients (16.7%) had true-positive PET-CT results, whereas 10 patients (83.3%) had false-negative scans, 1 patient (2.9%) had a false-positive result and 33 patients (97.1%) had a true-negative PET-CT. The sensitivity of PET-CT was 16.7% (95% confidence interval [CI], 3.5% to 46.0%) with a specificity of 97.1% (95% CI, 83.8% to 99.9%), positive predictive value (PPV) of 66.7% (95% CI, 20.2% to 94.4%), and negative predictive value (NPV) of 76.7% (95% CI, 62.1% to 87.0%). CONCLUSION PET-CT has poor sensitivity and NPV making PET-CT an imperfect predictor of nodal disease in recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 980-987, 2017.
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Affiliation(s)
- Andrew Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Mark Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Carol Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Gregory Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Francis Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ka Kit Wong
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
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Gvetadze SR, Xiong P, Lv M, Li J, Hu J, Ilkaev KD, Yang X, Sun J. Contrast-enhanced ultrasound mapping of sentinel lymph nodes in oral tongue cancer-a pilot study. Dentomaxillofac Radiol 2017; 46:20160345. [PMID: 28045344 DOI: 10.1259/dmfr.20160345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the usefulness of contrast-enhanced ultrasound (CEUS) with peritumoral injection of microbubble contrast agent for detecting the sentinel lymph nodes for oral tongue carcinoma. METHODS The study was carried out on 12 patients with T1-2cN0 oral tongue cancer. A radical resection of the primary disease was planned; a modified radical supraomohyoid neck dissection was reserved for patients with larger lesions (T2, n = 8). The treatment plan and execution were not influenced by sentinel node mapping outcome. The Sonovue™ contrast agent (Bracco Imaging, Milan, Italy) was utilized. After detection, the position and radiologic features of the sentinel nodes were recorded. RESULTS The identification rate of the sentinel nodes was 91.7%; one patient failed to demonstrate any enhanced areas. A total of 15 sentinel nodes were found in the rest of the 11 cases, with a mean of 1.4 nodes for each patient. The sentinel nodes were localized in: Level IA-1 (6.7%) node; Level IB-11 (73.3%) nodes; Level IIA-3 (20.0%) nodes. No contrast-related adverse effects were observed. CONCLUSIONS For oral tongue tumours, CEUS is a feasible and potentially widely available approach of sentinel node mapping. Further clinical research is required to establish the position of CEUS detection of the sentinel nodes in oral cavity cancers.
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Affiliation(s)
- Shalva R Gvetadze
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China.,2 Department of Reconstructive Maxillofacial Surgery with Microsurgery and External Prosthetics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.,3 Department of Consulting and Diagnostics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Ping Xiong
- 4 Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingming Lv
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jun Li
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jingzhou Hu
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Konstantin D Ilkaev
- 5 Department of Head and Neck Surgery, NN Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Xin Yang
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jian Sun
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Abouzied MM, Fathala A, Alsugair A, Muhaideb AIA, Qahtani MHA. Role of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in the Evaluation of Head and Neck Carcinoma. World J Nucl Med 2017; 16:257-265. [PMID: 29033672 PMCID: PMC5639440 DOI: 10.4103/wjnm.wjnm_40_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET-CT) has been playing a pivotal role in tumor imaging for the past 20 years. Head and neck (HN) cancers are a good example that can illustrate such unique role of FDG imaging contributing to the patient's management. In this review article, we will describe the normal physiological distribution of FDG within HN structures focusing on its limitations and pitfalls. In addition, we will be also describing its role in the initial staging and restaging of the disease, particularly with regard to therapy response assessment. Furthermore, its role in the evaluation of patients with malignant cervical adenopathy from an unknown primary will be described. In 2016, the Royal College of Radiologists in its third edition published evidence-based guidelines for PET-CT use in HN cancer emphasizing its rule in all these clinical scenarios that are being described in this review. Finally, we will be highlighting future directions in the field of molecular imaging of HN tumors with a special emphasis on the new PET tracers.
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Affiliation(s)
- Moheieldin M Abouzied
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ahmed Fathala
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Abdulaziz Alsugair
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ahmad I Al Muhaideb
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Mohammed H Al Qahtani
- Department of Cyclotron and Radiopharmaceuticals, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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Sohn B, Koh YW, Kang WJ, Lee JH, Shin NY, Kim J. Is there an additive value of 18 F-FDG PET-CT to CT/MRI for detecting nodal metastasis in oropharyngeal squamous cell carcinoma patients with palpably negative neck? Acta Radiol 2016; 57:1352-1359. [PMID: 26013025 DOI: 10.1177/0284185115587544] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cervical node metastasis is one of the most significant prognostic factors in patients with oropharyngeal squamous cell carcinoma (SCC). There is little information regarding the comparison of histopathologic analysis following neck dissection with imaging results in oropharyngeal SCC. Purpose To investigate the clinical utility of PET-CT compared with computed tomography (CT) or magnetic resonance imaging (MRI) for detecting nodal metastasis in oropharyngeal SCC patients with palpably negative neck and to investigate whether pretreatment imaging modalities support the rationale for elective neck treatment. Material and Methods A total of 49 oropharyngeal SCC patients with palpably negative neck (42 men, 7 women; average age, 59.1 years) underwent primary tumor resection and neck dissection as a primary treatment. All patients were preoperatively evaluated with PET-CT and CT/MRI, and the diagnostic accuracy of each imaging modality was assessed by comparison with histopathologic results of the surgical specimen. Results Twenty-five (51.0%) of our 49 patients had neck metastases. On a level-by-level analysis, the sensitivity of PET-CT, CT/MRI, and a combination of PET-CT and CT/MRI was 54.6%, 54.6%, and 60.6%, respectively, at all neck levels. The area under the ROC showed that the diagnostic performance of the combined interpretation was not significantly different from that of CT/MRI alone (0.780 vs. 0.750, respectively; P = 0.158) and PET-CT alone (0.780 vs. 0.765, respectively; P = 0.501). Conclusion Addition of PET-CT to CT/MRI did not provide better diagnostic accuracy for detecting nodal metastasis in preoperative evaluation of oropharyngeal SCC patients with palpably negative neck, suggesting that current imaging studies might not replace elective neck dissection.
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Affiliation(s)
- Beomseok Sohn
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Na-Young Shin
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinna Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Nguyen VD, Tantiwongkosi B, Weinheimer WJ, Miller FR. Positron-emission tomography/computed tomography imaging in head and neck oncology: An update. World J Otorhinolaryngol 2016; 6:23-32. [DOI: 10.5319/wjo.v6.i2.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/09/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma (HNSCC). Imaging studies such as contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) and 18F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography (18F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.
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Tomura N, Mizuno Y, Saginoya T. PET/CT findings for tumors in the base of the skull: comparison of 18 F-FDG with 11 C-methionine. Acta Radiol 2016; 57:325-32. [PMID: 25795702 DOI: 10.1177/0284185115575342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 02/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Positron emission tomography/computed tomography (PET/CT) using 18 F-fluorodeoxyglucose (FDG) has been used to characterize various malignancies. There are few reports regarding the use of 11 C-methionine (MET)-PET/CT to characterize tumors in the skull base. PURPOSE To compare MET-PET/CT with FDG-PET/CT in cases of tumors of the skull base. MATERIAL AND METHODS Both MET-PET/CT and FDG-PET/CT were performed in 27 patients with tumors of the skull base. In all cases, pathology was determined by surgery or biopsy. The images were visually and independently reviewed by two reviewers. For qualitative analysis, the inter-rater agreement between two reviewers was measured. For semi-quantitative evaluation, the tumor-to-normal brain uptake ratios (T/N ratios) were calculated by dividing the maximum of standardized uptake value (SUVmax) for the tumor by the SUVmax of the normal contra-lateral cerebellar hemisphere. Difference in T/N ratios between FDG-PET/CT and MET-PET/CT was analyzed for statistical significance. RESULTS On qualitative evaluation, the inter-rater agreement of MET-PET/CT was superior than that of FDG-PET/CT. MET uptake was interpreted as positive in every tumor by both reviewers. MET-PET/CT had a significantly higher T/N ratio than FDG-PET/CT (2.96 ± 1.25 vs. 1.02 ± 0.54, respectively; P < 0.001). CONCLUSION MET-PET/CT showed superior inter-rater agreement and had higher uptake for tumors at the skull base than FDG-PET/CT. The present study suggests that MET-PET/CT has superior potential for imaging of tumors of the skull base.
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Affiliation(s)
- Noriaki Tomura
- Department of Neuroradiology and Radiology, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Yasuaki Mizuno
- Department of Neuroradiology and Radiology, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Toshiyuki Saginoya
- Department of Neuroradiology and Radiology, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
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18F-FDG PET/CT quantification in head and neck squamous cell cancer: principles, technical issues and clinical applications. Eur J Nucl Med Mol Imaging 2016; 43:1360-75. [DOI: 10.1007/s00259-015-3294-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/14/2015] [Indexed: 01/28/2023]
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29
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[18F]-FDG PET/CT imaging for detection of nodal metastases in patients with squamous cell carcinoma of the pharynx and larynx: comparison with CT. Jpn J Radiol 2015; 34:203-10. [DOI: 10.1007/s11604-015-0510-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
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30
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Kitajima K, Suenaga Y, Minamikawa T, Komori T, Otsuki N, Nibu KI, Sasaki R, Itoh T, Sugimura K. Clinical significance of SUVmax in (18)F-FDG PET/CT scan for detecting nodal metastases in patients with oral squamous cell carcinoma. SPRINGERPLUS 2015; 4:718. [PMID: 26636006 PMCID: PMC4656255 DOI: 10.1186/s40064-015-1521-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022]
Abstract
To retrospectively investigate the diagnostic accuracy of FDG-PET/CT relative to CT for detection of cervical node metastases in patients with oral squamous cell carcinoma (OSCC), using histologic evaluation of dissected cervical nodes as the reference standard. Thirty-six patients with OSCC who underwent neck dissection (4 bilateral, 32 unilateral; 250 nodal levels) after FDG-PET/CT. Two observers consensually determined the lesion size and SUVmax of visible cervical nodes and compared the results with pathologic findings at the nodal level. Histopathology revealed nodal metastases in 13 (36.1 %) of 36 patients and 28 (11.2 %) of 250 nodal levels. Using a best discriminative SUVmax cut-off of 3.5 for the node, the sensitivity, specificity and accuracy of FDG-PET/CT for identification of nodal metastases on a level-by-level basis were 67.9, 94.6, and 91.6 %, respectively. The corresponding figures for CT were 42.9, 96.8, and 90.8 %, respectively. The sensitivity of FDG-PET/CT was significantly better than CT (p = 0.023). Moreover, using the level-based modified SUVmax cut-off, the respective figures for FDG-PET/CT were 71.4, 95.9, and 93.2 %, with significantly higher sensitivity (p = 0.013) and accuracy (p = 0.041) than CT. FDG PET/CT with SUVmax is a useful modality for preoperative evaluation of cervical neck lymph node metastases in patients with OSCC.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Yuko Suenaga
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ryohei Sasaki
- Department of Radiology, Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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Sarrión Pérez MG, Bagán JV, Jiménez Y, Margaix M, Marzal C. Utility of imaging techniques in the diagnosis of oral cancer. J Craniomaxillofac Surg 2015; 43:1880-94. [DOI: 10.1016/j.jcms.2015.07.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/05/2015] [Accepted: 07/30/2015] [Indexed: 02/07/2023] Open
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Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol 2015; 33:776-89. [DOI: 10.1007/s11604-015-0495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
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Schaarschmidt BM, Heusch P, Buchbender C, Ruhlmann M, Bergmann C, Ruhlmann V, Schlamann M, Antoch G, Forsting M, Wetter A. Locoregional tumour evaluation of squamous cell carcinoma in the head and neck area: a comparison between MRI, PET/CT and integrated PET/MRI. Eur J Nucl Med Mol Imaging 2015; 43:92-102. [PMID: 26243264 DOI: 10.1007/s00259-015-3145-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/14/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the accuracy of integrated (18)F-FDG PET/MR imaging for locoregional tumour evaluation compared to (18)F-FDG PET/CT and MR imaging in initial tumour and recurrence diagnosis in histopathologically confirmed head and neck squamous cell carcinoma (HNSCC). METHODS (18)F-FDG PET/CT and integrated (18)F-FDG PET/MR imaging were performed for initial tumour staging or recurrence diagnosis in 25 patients with HNSCC. MR, fused (18)F-FDG PET/CT and fused (18)F-FDG PET/MR images were analysed by two independent readers in separate sessions in random order. In initial tumour staging, T and N staging was performed while individual lesions were analysed in patients with suspected cancer recurrence. In T and N staging, histopathological results after tumour resection served as the reference standard while histopathological sampling as well as cross-sectional and clinical follow-up were accepted in cancer recurrence diagnosis. The diagnostic accuracy of each modality was calculated separately for T and N staging as well as for tumour recurrence, and compared using McNemar's test. Values of p <0.017 were considered statistically significant after Bonferroni correction. RESULTS In 12 patients undergoing (18)F-FDG PET/CT and (18)F-FDG PET/MR for initial tumour staging, T staging was accurate in 50 % with MRI, in 59 % with PET/CT and in 75 % with PET/MR while N staging was accurate in 75 % with MRI, in 77 % with PET/CT and in 71 % with PET/MR in relation to the reference standard. No significant differences were observed in T and N staging among the three modalities (p > 0.017). In 13 patients undergoing hybrid imaging for cancer recurrence diagnosis, diagnostic accuracy was 57 % with MRI and in 72 % with (18)F-FDG PET/CT and (18)F-FDG PET/MR, respectively. Again, no significant differences were found among the three modalities (p > 0.017). CONCLUSION In this initial study, no significant differences were found among (18)F-FDG PET/MR, (18)F-FDG PET/CT and MRI in local tumour staging and cancer recurrence diagnosis.
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Affiliation(s)
- Benedikt Michael Schaarschmidt
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. .,Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, 45147, Essen, Germany.
| | - Philipp Heusch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Christian Buchbender
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Marcus Ruhlmann
- Medical Faculty, Department of Nuclear Medicine, University Duisburg-Essen, 45147, Essen, Germany
| | - Christoph Bergmann
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Essen, 45147, Essen, Germany
| | - Verena Ruhlmann
- Medical Faculty, Department of Nuclear Medicine, University Duisburg-Essen, 45147, Essen, Germany
| | - Marc Schlamann
- Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, 45147, Essen, Germany.,Department of Neuroradiology, University Hospital Giessen, Marburg, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Michael Forsting
- Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, 45147, Essen, Germany
| | - Axel Wetter
- Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, 45147, Essen, Germany
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Can 3′-Deoxy-3′-(18F) Fluorothymidine Out Perform 2-Deoxy-2-(18F) Fluoro-d-Glucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Cervical Lymphadenopathy in Patients With Oral/Head and Neck Cancer? J Oral Maxillofac Surg 2015; 73:1420-8. [DOI: 10.1016/j.joms.2015.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/27/2014] [Accepted: 01/04/2015] [Indexed: 11/22/2022]
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Özel HE. Use of PET in Head and Neck Cancers. Turk Arch Otorhinolaryngol 2015; 53:73-76. [PMID: 29391984 PMCID: PMC5783004 DOI: 10.5152/tao.2015.863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
Head and neck cancer imaging is especially necessary for staging. Computed tomography and magnetic resonance imaging are the techniques frequently used for this purpose. These methods are valuable for displaying detailed anatomical structures; however, they may be inadequate for making the distinction between recurrence, residual tumor, fibrosis, and normal tissues with an altered anatomy after treatments such as surgery, radiotherapy, and chemotherapy and for the detection of metastases. From this point, positron emission tomography may be a promising imaging method. Scanning the entire body with a single method is an important advantage of positron emission tomography. It may be useful in the detection of synchronous tumors, which are a serious problem in head and neck cancers. Positron emission tomography may provide additional contribution for neck metastases, where the primary site is unknown and is undetectable by other imaging techniques.
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Affiliation(s)
- Halil Erdem Özel
- Department of Otorhinolaryngology, Derince Training and Research Hospital, Kocaeli, Turkey
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36
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Sun R, Tang X, Yang Y, Zhang C. (18)FDG-PET/CT for the detection of regional nodal metastasis in patients with head and neck cancer: a meta-analysis. Oral Oncol 2015; 51:314-20. [PMID: 25619735 DOI: 10.1016/j.oraloncology.2015.01.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/03/2015] [Accepted: 01/05/2015] [Indexed: 11/28/2022]
Abstract
We performed a meta-analysis to evaluate the role of (18)FDG-PET/CT for detection of regional nodal metastasis in patients with head and neck cancer (HNC). Studies about (18)FDG-PET/CT were systematically searched in the MEDLINE and EMBASE databases. The Stata software was used to obtain pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for (18)FDG-PET/CT. We also compared the performance of (18)FDG-PET/CT with that of conventional imaging (CT, MRI, and CT/MRI) by analyzing studies that had also used conventional imaging on the same patients. 24 articles bulled all inclusion criteria (1270 patients). The pooled per-patient, per-neck-side, and per-neck-level sensitivities/specificities for (18)FDG-PET/CT were 0.91/0.87, 0.84/0.83, and 0.80/0.96, respectively. Across 13 studies (3460 neck levels) with per-neck-level data, the sensitivity and specificity of PET-CT were 0.84 and 0.96, and of conventional imaging were 0.63 and 0.96, respectively. (18)FDG-PET/CT has good diagnostic performance for the detection of regional nodal metastasis in HNC patients. Compared with conventional imaging, (18)FDG-PET/CT may have higher per-neck-level sensitivity.
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Affiliation(s)
- Rong Sun
- Department of Physical Examination, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xinye Tang
- Departments of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing 400016, China; Pediatric Research Institute of Chongqing Medical University, Chongqing 400016, China; National Key Disciplinary Areas of Pediatrics, Ministry of Education, Chongqing 400016, China.
| | - Yang Yang
- Departments of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Cheng Zhang
- Departments of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing 400016, China
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Rohde M, Dyrvig AK, Johansen J, Sørensen JA, Gerke O, Nielsen AL, Høilund-Carlsen PF, Godballe C. 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography in diagnosis of head and neck squamous cell carcinoma: A systematic review and meta-analysis. Eur J Cancer 2014; 50:2271-9. [DOI: 10.1016/j.ejca.2014.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/18/2014] [Indexed: 11/16/2022]
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38
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Hong HR, Jin S, Koo HJ, Roh JL, Kim JS, Cho KJ, Choi SH, Nam SY, Kim SY. Clinical values of (18) F-FDG PET/CT in oral cavity cancer with dental artifacts on CT or MRI. J Surg Oncol 2014; 110:696-701. [PMID: 24995957 DOI: 10.1002/jso.23691] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/08/2014] [Indexed: 12/30/2022]
Abstract
LEVEL OF EVIDENCE 2a BACKGROUND AND OBJECTIVES To investigate the role of (18) F-FDG PET/CT in tumor staging, extent, and volume measurements in oral cavity squamous cell carcinoma (OSCC) patients with/without dental artifacts on CT or MRI. METHODS This study was conducted in 63 consecutive patients with OSCC who received initial workups including (18) F-FDG PET/CT and MRI. The results of the imaging modalities were compared to those of pathology, using McNemar's test and the paired t-test. RESULTS Thirty-seven patients (59%) had dental or metallic artifacts obscuring primary tumors. (18) F-FDG PET/CT scanning was superior to MRI in tumor staging (weighted κ = 0.870 vs. 0.518, P = 0.004) in patients with dental artifacts. In addition, (18) F-FDG PET/CT scans were more specific than MRI in detecting sublingual gland (P = 0.014) and mouth floor (P = 0.011) involvement. In patients with dental artifacts, there was a significant discrepancy between primary tumor volume (PTV) measured by pathology and MRI (P = 0.018), but not between PTV measured from pathology and (18) F-FDG PET/CT at SUV2.5 (P = 0.245), which showed the highest intraclass correlation coefficient value (0.860). CONCLUSION (18) F-FDG PET/CT scans provide accurate tumor staging and volume measurements in OSCC patients with CR/MRI dental artifacts, leading to improved preoperative planning. LEVEL OF EVIDENCE 2b CONDENSED ABSTRACT This study evaluated the clinical value of (18) F-FDG PET/CT in 63 patients with oral cavity cancers. In 37 (59%) patients with dental artifacts on CT/MRI, (18) F-FDG PET/CT showed superior results compared to MRI in tumor staging and represented the highest intraclass correlation coefficient value to tumor volume determined by pathology.
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Affiliation(s)
- Hye Ran Hong
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hassan O, Taha MS, Farag W. Diffusion-weighted MRI versus PET/CT in evaluation of clinically N0 neck in patients with HNSCC. Systematic review and meta-analysis study. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.ejenta.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Driessen JP, van Kempen PMW, van der Heijden GJ, Philippens MEP, Pameijer FA, Stegeman I, Terhaard CHJ, Janssen LM, Grolman W. Diffusion-weighted imaging in head and neck squamous cell carcinomas: A systematic review. Head Neck 2014; 37:440-8. [DOI: 10.1002/hed.23575] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 11/17/2013] [Accepted: 12/10/2013] [Indexed: 12/24/2022] Open
Affiliation(s)
- Juliette P. Driessen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
| | - Paulina M. W. van Kempen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Geert J. van der Heijden
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Frank A. Pameijer
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
| | - Chris H. J. Terhaard
- Department of Radiotherapy; University Medical Center Utrecht; Utrecht The Netherlands
| | - Luuk M. Janssen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
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Jocić M, Petrović S, Stojanov D. ADVANCED DIAGNOSTIC TECHNIQUES OF METASTATIC NECK LYMPH NODES. ACTA MEDICA MEDIANAE 2013. [DOI: 10.5633/amm.2013.0410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Geum DH, Roh YC, Yoon SY, Kim HG, Lee JH, Song JM, Lee JY, Hwang DS, Kim YD, Shin SH, Chung IK, Kim UK. The impact factors on 5-year survival rate in patients operated with oral cancer. J Korean Assoc Oral Maxillofac Surg 2013; 39:207-16. [PMID: 24471047 PMCID: PMC3858143 DOI: 10.5125/jkaoms.2013.39.5.207] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 11/07/2022] Open
Abstract
Objectives The purpose of this study is to analyze clinical impact factors on the survival rate, and to acquire basic clinical data for the diagnosis of oral cancer, for a determination of the treatment plan with long-term survival in oral cancer patients. Materials and Methods Through a retrospective review of the medical records, the factors for long-term survival rate were analyzed. Thirty-seven patients, among patient database with oral cancer treated in the Department of Oral and Maxillofacial Surgery at Pusan National University Hospital within a period from March 1998 to March 2008, were selected within the study criteria and were followed-up for more than 5 years. The analyzed factors were gender, age, drinking, smoking, primary tumor site, type of cancer, TNM stage, recurrence of affected region, and metastasis of cervical lymph node. The 5-year survival rate on the impact factors was calculated statistically using the Kaplan-Meier method. Results By classification of clinical TNM at the 1st visit, there were 11 (29.7%) cases for stage I, 11 (29.7%) cases for stage II, 3 (8.1%) cases for stage III, and 12 (32.5%) cases for stage IV. The 5-year survival rate of total oral cancer patients after the operation were 75.7%, pathological TNM stage related 5-year survival rate were as follows: stage I 90.0%, stage II 81.8%, stage III 100% and stage IV 45.5%; in which the survival rate difference by each stage was significantly observed. The recurrence of cervical lymph node was the significant impact factor for the survival rate, because only 30.0% the survival rate in recurrent cases existed. During the follow-up, there were 15 (40.5%) patients with confirmed recurrence, and the 5-year survival rate of these patients was decreased as 46.7%. Conclusion The classification of clinical and pathological TNM stage, local recurrence after surgery, and metastasis of cervical lymph node after surgery were analyzed as the 3 most significant factors.
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Affiliation(s)
- Dong-Ho Geum
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Young-Chea Roh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sang-Yong Yoon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Hyo-Geon Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jung-Han Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae-Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae-Yeol Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Dae-Seok Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - In-Kyo Chung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Uk-Kyu Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
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Effectiveness of PET/CT in the preoperative evaluation of neck disease. Laryngoscope 2013; 124:159-64. [DOI: 10.1002/lary.24329] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/27/2013] [Accepted: 07/08/2013] [Indexed: 11/07/2022]
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Yongkui L, Jian L, Jingui L. 18FDG-PET/CT for the detection of regional nodal metastasis in patients with primary head and neck cancer before treatment: a meta-analysis. Surg Oncol 2013; 22:e11-6. [PMID: 23538049 DOI: 10.1016/j.suronc.2013.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/28/2013] [Accepted: 02/03/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND We performed a meta-analysis to evaluate the role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET/CT) in the detection of regional nodal metastasis in patients with primary head and neck cancer before treatment. MATERIALS AND METHODS Studies about (18)FDG-PET/CT for the detection of regional nodal metastasis in patients with primary HNC were systematically searched in the MEDLINE, EMBASE, and EBM Review databases from January 1, 2000 to July 25, 2012. A software called "Stata 12.0" was used to obtain pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for PET/CT. We also calculated hierarchic summary receiver operating characteristic (HSROC) curves and area under the curves. RESULTS 14 articles (742 patients) fulfilled all inclusion criteria. The pooled sensitivity, and specificity with 95% confidence interval for PET/CT on a per-neck-side analysis were 0.84 (0.77-0.89) and 0.84 (0.78-0.89). The corresponding values for PET/CT on a per-nodal-level analysis 0.84 (0.78-0.88) and 0.96 (0.94-0.98). CONCLUSIONS (18)FDG-PET/CT had good diagnostic performance for the detection of regional nodal metastasis in patients with primary head and neck cancer before treatment.
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Affiliation(s)
- Lu Yongkui
- Department of Medical Oncology, Tumor Hospital of Guangxi Medical University, Nanning 530021, PR China.
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Teymoortash A, Werner JA. Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc04. [PMID: 23320056 PMCID: PMC3544246 DOI: 10.3205/cto000086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role.
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Affiliation(s)
- A. Teymoortash
- Department of Otolaryngology, Head & Neck Surgery, University of
Marburg, Germany
| | - J. A. Werner
- Department of Otolaryngology, Head & Neck Surgery, University of
Marburg, Germany
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Wolff KD, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:829-35. [PMID: 23248713 DOI: 10.3238/arztebl.2012.0829] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/04/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND About 10,000 persons are diagnosed as having carcinoma of the oral cavity or the throat in Germany every year. Squamous-cell carcinoma accounts for 95% of cases. METHODS We systematically reviewed the pertinent literature on predefined key questions about these tumors (which were agreed upon by a consensus of the investigators), concerning imaging, the removal of cervical lymph nodes, and resection of the primary tumor. RESULTS 246 clinical trials were selected for review on the basis of 3014 abstracts. There was only one randomized, controlled trial (evidence level 1-); the remaining trials reached evidence levels 2++ to 3. Patients with mucosal changes of an unclear nature persisting for more than two weeks should be examined by a specialist without delay. The diagnosis is made by computed tomography or magnetic resonance imaging along with biopsy and a standardized histopathological examination. Occult metastases are present in 20% to 40% of cases. Advanced disease (stages T3 and T4) should be treated by surgery followed by radiotherapy, with or without chemotherapy. 20% of the patients overall go on to have a recurrence, usually within 2 to 3 years of the initial treatment. The 5-year survival rate is somewhat above 50%. Depending on the radicality of surgery and radiotherapy, there may be functional deficits, osteoradionecrosis, and xerostomia. The rate of loss of implants in irradiated bone is about 10% in 3 years. CONCLUSION The interdisciplinary planning and implementation of treatment, based on the patient's individual constellation of findings and personal wishes, are prerequisites for therapeutic success. Reconstructive measures, particularly microsurgical ones, have proven their usefulness and are an established component of surgical treatment.
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Affiliation(s)
- Klaus-Dietrich Wolff
- Clinic and Policlinic for Oro-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Preoperative evaluation of patients with squamous cell carcinoma of the oral cavity: fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography and ultrasonography versus histopathology. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:516-25. [DOI: 10.1016/j.oooo.2012.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/28/2012] [Accepted: 06/01/2012] [Indexed: 11/19/2022]
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Yoo J, Henderson S, Walker-Dilks C. Evidence-based guideline recommendations on the use of positron emission tomography imaging in head and neck cancer. Clin Oncol (R Coll Radiol) 2012; 25:e33-66. [PMID: 23021712 DOI: 10.1016/j.clon.2012.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/26/2012] [Indexed: 02/07/2023]
Abstract
AIMS To provide evidence-based practice guideline recommendations on the use of fluoro-2-deoxy-D-glucose positron emission tomography (PET) for diagnosis, staging and assessing treatment response, restaging or recurrence of head and neck cancer. MATERIALS AND METHODS A systematic review by Facey et al. (Health Technology Assessment 2007;11(44):iii-iv, xi-267) was used as the evidence base for recommendation development. As the review was limited to August 2005, the evidence base was updated to July 2011 using the same search strategies for MEDLINE and EMBASE used in the original review. The authors of the current systematic review drafted recommendations, which were reviewed, adapted and accepted by consensus by the Ontario provincial Head and Neck Disease Site Group and a special meeting of clinical experts. RESULTS The results of the Facey et al. review for head and neck cancer included five other systematic reviews and 31 primary studies. The 2005 to 2011 update search included four additional systematic reviews and 53 primary studies. Recommendations were developed based on this evidence and accepted by consensus. CONCLUSIONS PET is recommended in the M and bilateral nodal staging of all patients with head and neck squamous cell carcinoma where conventional imaging is equivocal, or where treatment may be significantly modified. PET is recommended in all patients after conventional imaging and in addition to, or prior to, diagnostic panendoscopy where the primary site is unknown. PET is recommended for the staging and assessment of recurrence of patients with nasopharyngeal carcinoma if conventional imaging is equivocal. PET is recommended for restaging patients who are being considered for major salvage treatment, including neck dissection.
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Affiliation(s)
- J Yoo
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, Victoria Hospital, London Health Sciences Centre, Ontario, Canada
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The use of multiple time point dynamic positron emission tomography/computed tomography in patients with oral/head and neck cancer does not predictably identify metastatic cervical lymph nodes. J Oral Maxillofac Surg 2012; 71:162-77. [PMID: 22742956 DOI: 10.1016/j.joms.2012.03.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine whether the time course of 18-fluorine fluorodeoxyglucose (18F-FDG) activity in multiple consecutively obtained 18F-FDG positron emission tomography (PET)/computed tomography (CT) scans predictably identifies metastatic cervical adenopathy in patients with oral/head and neck cancer. It is hypothesized that the activity will increase significantly over time only in those lymph nodes harboring metastatic cancer. PATIENTS AND METHODS A prospective cohort study was performed whereby patients with oral/head and neck cancer underwent consecutive imaging at 9 time points with PET/CT from 60 to 115 minutes after injection with (18)F-FDG. The primary predictor variable was the status of the lymph nodes based on dynamic PET/CT imaging. Metastatic lymph nodes were defined as those that showed an increase greater than or equal to 10% over the baseline standard uptake values. The primary outcome variable was the pathologic status of the lymph node. RESULTS A total of 2,237 lymph nodes were evaluated histopathologically in the 83 neck dissections that were performed in 74 patients. A total of 119 lymph nodes were noted to have hypermetabolic activity on the 90-minute (static) portion of the study and were able to be assessed by time points. When we compared the PET/CT time point (dynamic) data with the histopathologic analysis of the lymph nodes, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 60.3%, 70.5%, 66.0%, 65.2%, and 65.5%, respectively. CONCLUSIONS The use of dynamic PET/CT imaging does not permit the ablative surgeon to depend only on the results of the PET/CT study to determine which patients will benefit from neck dissection. As such, we maintain that surgeons should continue to rely on clinical judgment and maintain a low threshold for executing neck dissection in patients with oral/head and neck cancer, including those patients with N0 neck designations.
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Clinical significance of combined assessment of the maximum standardized uptake value of F-18 FDG PET with nodal size in the diagnosis of cervical lymph node metastasis of oral squamous cell carcinoma. Acad Radiol 2012; 19:708-17. [PMID: 22484437 DOI: 10.1016/j.acra.2012.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/15/2012] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to elucidate the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for nodal involvement in oral squamous cell carcinoma (OSCC), and to reveal clinically useful factors to distinguish between true-positive (TP) and false-positive (FP) nodes. MATERIALS AND METHODS Thirty-eight patients with primary OSCC who underwent neck dissection were assessed. The diagnostic accuracy of F-18 FDG PET/CT was evaluated, and then compared with that of CT/ultrasonography (US). Furthermore, the association of the maximum standardized uptake value (SUVmax) and nodal size with the histopathologic findings was examined. RESULTS Sensitivity and specificity using F-18 FDG PET/CT were 77.1% and 97.3%, and those using CT/US were 72.9% and 98.9%, respectively. The SUVmax of TP nodes was significantly higher than that of FP nodes. Nodes with SUVmax >4.5 were pathologically confirmed as metastasis. Nodes with SUVmax ≤4.5 were further discriminated between TP and FP nodes by using the long axis diameters or the ratios of long to short axis diameter as clinical parameters. Positive correlation between the SUVmax and the short-axis diameter was found in TP nodes. The AUC obtained from the ROC curves of the SUVmax alone (AUC, 0.804) was improved by combination with the long-axis diameter (AUC, 0.867) or the short-axis diameter (AUC, 0.846), although no significant difference was found. CONCLUSIONS These results indicated that F-18 FDG PET/CT was potentially useful in diagnosing preoperative nodal state. Furthermore, combined assessment of SUVmax with nodal size could be significant in the identification of metastatic lymph nodes in OSCC patients.
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