1
|
Kojima I, Takanami K, Ogawa T, Ishikawa K, Morishita Y, Ishii R, Ohkoshi A, Nakanome A, Odagiri H, Iikubo M. High diagnostic accuracy for lymph node metastasis of oral squamous cell carcinoma using PET/CT with a silicon photomultiplier. Oral Radiol 2022; 38:540-549. [PMID: 35061164 DOI: 10.1007/s11282-022-00588-0] [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: 08/10/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The higher sensitivity of the new-generation positron emission tomography/computed tomography (PET/CT) with silicon photomultiplier (SiPM) may increase false-positive rates in detecting metastatic lymph nodes (LNs). This study aimed to clarify the usefulness of the SiPM PET scanner in diagnosing LN metastasis of oral squamous cell carcinoma (SCC). METHODS We retrospectively reviewed consecutive F-18 fluorodeoxyglucose PET/CT images of 39 SCC patients using SiPM PET and 31 SCC patients using non-SiPM PET. We measured the maximum standardized uptake value (SUVmax) of the LNs on PET images and maximum short-axis diameter on transverse CT images. RESULTS The sensitivity and specificity of SiPM PET were 86.2% and 95.6%, respectively (cut-off SUVmax, 4.6). The area under the curve (AUC) of SiPM PET (0.977; 95% confidence interval [CI], 0.958-0.995) was significantly higher than that of non-SiPM PET (0.825; 95% CI 0.717-0.934) (P < 0.01). In a size-limited analysis of diameter, the AUC of SiPM PET (≥ 0.96 for all diameters) was significantly higher than that of non-SiPM PET (tended to decrease as the LN diameter decreased) for the diagnosis of LN metastasis by SUVmax. CONCLUSION SiPM PET had higher diagnostic accuracy for LN metastasis of oral SCC than non-SiPM PET, even for small LN metastasis without increasing false-positives.
Collapse
Affiliation(s)
- Ikuho Kojima
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. .,Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takenori Ogawa
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology, Gifu University Hospital, 1-1 Yanagido, Gifu city, 501-1194, Japan
| | - Kenichiro Ishikawa
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yohei Morishita
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ryo Ishii
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Akira Ohkoshi
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ayako Nakanome
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hayato Odagiri
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Iikubo
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| |
Collapse
|
2
|
Elicin O, Vollnberg B, Shelan M, Riggenbach E, Bojaxhiu B, Mathier E, Giger R, Aebersold DM, Klaeser B. Impact of pretreatment second look 18FDG-PET/CT on stage and treatment changes in head and neck cancer. Clin Transl Radiat Oncol 2021; 31:8-13. [PMID: 34504959 PMCID: PMC8414040 DOI: 10.1016/j.ctro.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/05/2022] Open
Abstract
The potential value of a second look PET/CT prior to radiotherapy was investigated. New lymph node metastases were discovered in half of the patients. Progression of the primary tumor and distant metastases were also observed. This strategy led to changes in treatment planning in more than half of the cases.
Background Patients diagnosed with locoregionally advanced head and neck squamous cell carcinoma (LAHNSCC) regularly undergo staging with 18F-FDG PET/CT in our center. In cases of delays in radiotherapy (RT) planning CT more than 4 weeks after initial PET/CT or clinically suspected progress, PET/CT is repeated for restaging and as an RT planning reference. Our aim was to determine the impact of second-look PET/CT on stage migration, treatment change and RT planning. Methods Consequent treatment changes were categorized as minor and major. Minor changes were defined as PET/CT-based modifications of RT plans, e.g., the addition of anatomical compartments, changes in high- and low-risk dose levels or both. Major changes included changes from curative to palliative treatment intent and alterations of interdisciplinary treatment plans, such as the addition of induction chemotherapy, switch to primary surgery, no treatment and/or the necessity of additional diagnostic work-up resulting in the postponement or cancellation of treatment. Results Thirty-two newly diagnosed LAHNSCC patients who were treated between 2014 and 2018 underwent second-look PET/CT (median interval 42.5 days). Second-look PET/CT led to locoregional and distant upstaging in 3/32 and 1/32 patients, respectively. In 1/32 patients (3%), second-look PET/CT led to a palliative approach with systemic treatment. New lymph node metastases were discovered in 16 patients, 6 of whom also showed significant progression of the primary tumor, resulting in minor changes in 16 of the remaining 31 patients (52%) who were treated curatively. Conclusion If RT treatment planning of LAHNSCC was delayed by more than 4 weeks after initial PET/CT staging or when progression was clinically suspected, a second look at 18FDG-PET/CT was performed. This led to changes in treatment planning in more than half of the cases, which is expected to directly influence oncologic outcomes.
Collapse
Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernd Vollnberg
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Riggenbach
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, City Hospital Triemli, Zurich, Switzerland
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernd Klaeser
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
| |
Collapse
|
3
|
Mihailovic J, Killeen RP, Duignan JA. PET/CT Variants and Pitfalls in Head and Neck Cancers Including Thyroid Cancer. Semin Nucl Med 2021; 51:419-440. [PMID: 33947603 DOI: 10.1053/j.semnuclmed.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PET/CT imaging is a dual-modality diagnostic technology that merges metabolic and structural imaging. There are several currently available radiotracers, but 18F-FDG is the most commonly utilized due to its widespread availability. 18F-FDG PET/CT is a cornerstone of head and neck squamous cell carcinoma imaging. 68Ga-DOTA-TOC is another widely used radiotracer. It allows for whole-body imaging of cellular somatostatin receptors, commonly expressed by neuroendocrine tumors and is the standard of reference for the characterization and staging of neuroendocrine tumors. The normal biodistribution of these PET radiotracers as well as the technical aspects of image acquisition and inadequate patient preparation affect the quality of PET/CT imaging. In addition, normal variants, artifacts and incidental findings may impede accurate image interpretation and can potentially lead to misdiagnosis. In order to correctly interpret PET/CT imaging, it is necessary to have a comprehensive knowledge of the normal anatomy of the head and neck and to be cognizant of potential imaging pitfalls. The interpreter must be familiar with benign conditions which may accumulate radiotracer potentially mimicking neoplastic processes and also be aware of malignancies which can demonstrate low radiotracer uptake. Appropriate use of structural imaging with either CT, MR or ultrasound can serve a complimentary role in several head and neck pathologies including local tumor staging, detection of bone marrow involvement or perineural spread, and classification of thyroid nodules. It is important to be aware of the role of these complementary modalities to maximize diagnostic accuracy and patient outcomes. The purpose of this article is to outline the basic principles of PET/CT imaging, with a focus on 18F-FDG PET/CT and 68Ga-DOTA PET/CT. Basic physiology, variant imaging appearances and potential pitfalls of image interpretation are presented within the context of common use cases of PET technology in patients with head and neck cancers and other pathologies, benign and malignant.
Collapse
Affiliation(s)
- Jasna Mihailovic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Centre of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.
| | - Ronan P Killeen
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John A Duignan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Jain M, Sarin A, Suhag V, Gahlot GPS, Jain A, Bandhopadhya A. Comparison of Efficacy of Positron Emission Tomography/Computed Tomography with Contrast-Enhanced Computed Tomography in Pretreatment Evaluation of Head and Neck Cancers: An Institutional Experience. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_226_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: Head and neck squamous cell carcinomas (SCCs) constitute 5.4% of all cancers worldwide, and 23% of all cancers in males and 6% of all cancers in females diagnosed in India. Lots of ambiguity exists in primary, nodal, and metastatic workup of these patients, especially in developing countries. Aim: The study was designed to compare the accuracy of whole-body positron emission tomography/computed tomography (WBPET/CT) scan with contrast-enhanced CT (CECT) face and neck as pretreatment evaluation for staging workup and management decision and to confirm the nodal findings on imaging with fine-needle aspiration cytology (FNAC). Design: It was a single-institute, prospective, observational, interventional study over a 2-year period. All cases of SCC of upper aerodigestive tract who were scheduled for definitive treatment concurrent chemoradiotherapy or radiotherapy were evaluated with routine investigations followed by imaging in the form of CECT face and neck and 18F-fluorodeoxyglucose (FDG) WBPET/CT. Results: In the 40 enrolled patients, all underwent CECT face and neck and WBPET/CT. During initial workup, biopsy was taken from primary site and FNAC was done from neck nodes for diagnosis and for staging. In 40 patients, CECT neck showed nodal metastasis in 39 patients; however, FNAC came positive in 38 cases. PET/CT showed nodal metastasis in 38 patients; however, FNAC came positive in 38 cases. Any node with Standardized uptake value (SUV) >2.5 was taken as suspicious lesion and FNAC was done. Sensitivity of CECT and PET/CT was 97.36% and 100%, respectively, while the specificity was 0% and 100%, respectively. Positive predictive value calculated for CECT and WBPET was 94.87% and 100%, respectively, while the negative predictive value for CECT and WBPET was 0% and 100%, respectively. Conclusion: In head and neck SCC, FDG-PET/CT is more accurate than CECT in staging of the neck.
Collapse
Affiliation(s)
- Mayuri Jain
- Departments of Radiation Oncology, Army Hospital RnR, New Delhi, India
| | - Arti Sarin
- Departments of Radiation Oncology, Army Hospital RnR, New Delhi, India
| | - V Suhag
- Departments of Radiation Oncology, Army Hospital RnR, New Delhi, India
| | - GPS Gahlot
- Departments of Pathology, Army Hospital RnR, New Delhi, India
| | - Anurag Jain
- Departments of Nuclear Medicine, Army Hospital RnR, New Delhi, India
| | - A Bandhopadhya
- Departments of Surgical Oncology, Army Hospital RnR, New Delhi, India
| |
Collapse
|
6
|
Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
Collapse
Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
7
|
Imaging features of sinonasal tumors on positron emission tomography and magnetic resonance imaging including diffusion weighted imaging: A pictorial review. Clin Imaging 2018; 51:217-228. [DOI: 10.1016/j.clinimag.2018.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022]
|
8
|
Peacock ZS, Krishnan DG. Advances in Imaging Over 100 Years: The Impact on Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2018; 76:1387-1399. [DOI: 10.1016/j.joms.2018.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
|
9
|
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]
|
10
|
Lopez R, Gantet P, Julian A, Hitzel A, Herbault-Barres B, Alshehri S, Payoux P. Value of PET/CT 3D visualization of head and neck squamous cell carcinoma extended to mandible. J Craniomaxillofac Surg 2018; 46:743-748. [PMID: 29567343 DOI: 10.1016/j.jcms.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/29/2018] [Accepted: 02/13/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To study an original 3D visualization of head and neck squamous cell carcinoma extending to the mandible by using [18F]-NaF PET/CT and [18F]-FDG PET/CT imaging along with a new innovative FDG and NaF image analysis using dedicated software. The main interest of the 3D evaluation is to have a better visualization of bone extension in such cancers and that could also avoid unsatisfying surgical treatment later on. PATIENTS AND METHODS A prospective study was carried out from November 2016 to September 2017. Twenty patients with head and neck squamous cell carcinoma extending to the mandible (stage 4 in the UICC classification) underwent [18F]-NaF and [18F]-FDG PET/CT. We compared the delineation of 3D quantification obtained with [18F]-NaF and [18F]-FDG PET/CT. In order to carry out this comparison, a method of visualisation and quantification of PET images was developed. This new approach was based on a process of quantification of radioactive activity within the mandibular bone that objectively defined the significant limits of this activity on PET images and on a 3D visualization. Furthermore, the spatial limits obtained by analysis of the PET/CT 3D images were compared to those obtained by histopathological examination of mandibular resection which confirmed intraosseous extension to the mandible. RESULTS The [18F]-NaF PET/CT imaging confirmed the mandibular extension in 85% of cases and was not shown in [18F]-FDG PET/CT imaging. The [18F]-NaF PET/CT was significantly more accurate than [18F]-FDG PET/CT in 3D assessment of intraosseous extension of head and neck squamous cell carcinoma. This new 3D information shows the importance in the imaging approach of cancers. All cases of mandibular extension suspected on [18F]-NaF PET/CT imaging were confirmed based on histopathological results as a reference. CONCLUSIONS The [18F]-NaF PET/CT 3D visualization should be included in the pre-treatment workups of head and neck cancers. With the use of a dedicated software which enables objective delineation of radioactive activity within the bone, it gives a very encouraging results. The [18F]-FDG PET/CT appears insufficient to confirm mandibular extension. This new 3D simulation management is expected to avoid under treatment of patients with intraosseous mandibular extension of head and neck cancers. However, there is also a need for a further study that will compare the interest of PET/CT and PET/MRI in this indication.
Collapse
Affiliation(s)
- R Lopez
- Université de Toulouse, UPS, F-31059 Toulouse, France; Inserm, Imagerie cérébrale et handicaps neurologiques, UMR 825, F-31059 Toulouse, France; Department of Oral and Maxillofacial Surgery, Purpan Hospital, Place du Dr Baylac, 31059 Toulouse Cedex 9, France.
| | - P Gantet
- Université de Toulouse, UPS, F-31059 Toulouse, France; Department of Nuclear Medicine, Purpan Hospital, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - A Julian
- Department of Nuclear Medicine, Purpan Hospital, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - A Hitzel
- Université de Toulouse, UPS, F-31059 Toulouse, France; Department of Nuclear Medicine, Purpan Hospital, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - B Herbault-Barres
- Department of anatomopathology, Purpan Hospital, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| | - S Alshehri
- Department of Otolaryngology, King Khalid University, College of Medicine, Saudi Arabia
| | - P Payoux
- Université de Toulouse, UPS, F-31059 Toulouse, France; Inserm, Imagerie cérébrale et handicaps neurologiques, UMR 825, F-31059 Toulouse, France; Department of Nuclear Medicine, Purpan Hospital, Place du Dr Baylac, 31059 Toulouse Cedex 9, France
| |
Collapse
|
11
|
|
12
|
Hybrid PET/MRI-based delineation of gross tumor volume in head and neck cancer and tumor parameter analysis. Nucl Med Commun 2018; 38:642-649. [PMID: 28489688 DOI: 10.1097/mnm.0000000000000687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Accurate target delineation allows an increase in radiation dose to the target tumor while reducing damage to the surrounding normal tissue. However, there is currently no standard for evaluating volumes measured by different imaging modalities. The aim of this study is to evaluate the feasibility of contouring gross tumor volume (GTV) by PET/MRI in head and neck cancer, and to define an adaptive threshold level (aTL) for delineating the biological target volume (BTV). PATIENTS AND METHODS Eighteen head and neck cancer patients underwent time of flight PET/MRI before chemoradiotherapy. Different GTVs of primary tumors and metastatic lymph nodes were manually contoured on MRI (GTVMRI), PET (GTVVIS), and fused PET/MRI (GTVFUS). An MRI-based GTV contour was substituted for the pathologic GTV. The percentile threshold boundary of the maximum standardized uptake value (SUVmax) for the BTV was determined when the volume of BTV approached that of GTVMRI. RESULTS All GTVs were highly correlated (all Pearson's r>0.85, all P<0.001). Tumor diameter strongly correlated with GTVs (r=0.7-0.8 for all lesions and primary tumor; r=0.8-0.9 for lymph node metastases). aTL and SUVmax were moderately correlated for all lesions (r=-0.692, P<0.001) and were strongly correlated for primary tumors (r=-0.866, P<0.001). CONCLUSION Delineating GTV on hybrid PET/MRIs is feasible, and aTL, the threshold boundary of BTV, was correlated inversely with the SUVmax.
Collapse
|
13
|
Ceylan Y, Ömür Ö, Hatipoğlu F. Contribution of 18F-FDG PET/CT to Staging of Head and Neck Malignancies. Mol Imaging Radionucl Ther 2018; 27:19-24. [PMID: 29393049 PMCID: PMC5790968 DOI: 10.4274/mirt.51423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Accurate staging of head and neck cancer (HNC) plays an important role in patient management as well as protection of functional characteristics of the head and neck region. Our aim was to investigate the contribution of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) as part of HNC staging to clinical evaluation and treatment planning. METHODS Clinical records of 138 HNC cases who has undergone 18F-FDG PET/CT imaging were retrospectively reviewed. Sixty-five cases who had accessible clinical follow-up data were included in the study group, and their PET/CT and conventional imaging findings were evaluated. RESULTS In the case group with a PET/CT and magnetic resonance imaging (MRI) for evaluation of primary lesion the sensitivity rates for PET/CT and MRI were calculated as 91.3% and 82.6%, the positive predictive values (PPV) as 91.3% and 82.6%, specificity as 71.4% and 42.8%, and the negative predictive value (NPV) as 71.4% and 42.8%, respectively. In terms of metastatic lymph node evaluation, the sensitivity was calculated as 100% and 88.8%, the NPV as 100% and 83.3%, respectively. The PPV and specificity was 100% for both modalities. In the case group with CT for primary lesion evaluation, the sensitivity and PPV were found as 95.2% and 100% for PET/CT, and as 85.7% and 94.7% for CT, respectively. in metastatic lymph node evaluation, the sensitivity was found as 100% for PET/CT and 50% for CT, and the PPV, specificity and NPV were determined as 100% for both methods. PET/CT findings resulted in a change in 'tumor, node, metastasis' staging in 5 cases. CONCLUSIONS PET/CT in HNC contributes to staging, thus playing a role in treatment planning, especially in patients with locally advanced disease.
Collapse
Affiliation(s)
- Yeşim Ceylan
- Adıyaman Faculty of Medicine, Training and Research Hospital, Clinic of Nuclear Medicine, Adıyaman, Turkey
| | - Özgür Ömür
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | | |
Collapse
|
14
|
Clinical Practice in PET/CT for the Management of Head and Neck Squamous Cell Cancer. AJR Am J Roentgenol 2017; 209:289-303. [PMID: 28731808 DOI: 10.2214/ajr.17.18301] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to summarize the evidence for the value of PET/CT for the management of patients with head and neck squamous cell cancer and suggest best clinical practices. CONCLUSION FDG PET/CT is a valuable imaging tool for identifying unknown primary tumors in patients with known cervical node metastases leading to management change and is the standard of care for the initial staging of stage III and IV head and neck squamous cell carcinomas (HNSCCs), for assessing therapy response when performed at least 12 weeks after chemoradiation therapy, and for avoiding unnecessary planned neck dissection. Neck dissection is avoided if PET/CT findings are negative-regardless of the size of the residual neck nodes-because survival outcomes are not compromised. FDG PET/CT is valuable in detecting recurrences and metastases during follow-up when suspected because of clinical symptoms and serves as a prognostic marker for patient survival outcomes, for 5 years. Using FDG PET/CT for routine surveillance of HNSCC after 6 months of treatment without any clinical suspicion should be discouraged.
Collapse
|
15
|
Huang EP, Lin FI, Shankar LK. Beyond Correlations, Sensitivities, and Specificities: A Roadmap for Demonstrating Utility of Advanced Imaging in Oncology Treatment and Clinical Trial Design. Acad Radiol 2017; 24:1036-1049. [PMID: 28456570 DOI: 10.1016/j.acra.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/05/2017] [Accepted: 03/02/2017] [Indexed: 12/13/2022]
Abstract
Despite the widespread belief that advanced imaging should be very helpful in guiding oncology treatment decision and improving efficiency and success rates in treatment clinical trials, its acceptance has been slow. Part of this is likely attributable to gaps in study design and statistical methodology for these imaging studies. Also, results supporting the performance of the imaging in these roles have largely been insufficient to justify their use within the design of a clinical trial or in treatment decision making. Statistically significant correlations between the imaging results and clinical outcomes are often incorrectly taken as evidence of adequate performance. Assessments of whether the imaging can outperform standard techniques or meaningfully supplement them are also frequently neglected. This paper provides guidance on study designs and statistical analyses for evaluating the performance of advanced imaging in the various roles in treatment decision guidance and clinical trial conduct. Relevant methodology from the imaging literature is reviewed; gaps in the literature are addressed using related concepts from the more extensive genomic and in vitro biomarker literature.
Collapse
Affiliation(s)
- Erich P Huang
- Biometric Research Program, Division of Cancer Treatment, Diagnosis National Cancer Institute, NIH, 9609 Medical Center Drive, MSC 9735, Bethesda, MD 20892-9735.
| | - Frank I Lin
- Cancer Imaging Program, Division of Cancer Treatment, Diagnosis National Cancer Institute, NIH, Bethesda, Maryland
| | - Lalitha K Shankar
- Cancer Imaging Program, Division of Cancer Treatment, Diagnosis National Cancer Institute, NIH, Bethesda, Maryland
| |
Collapse
|
16
|
Lopez R, Gantet P, Salabert AS, Julian A, Hitzel A, Herbault-Barres B, Fontan C, Alshehri S, Payoux P. Prospective comparison of 18F-NaF PET/CT versus 18F-FDG PET/CT imaging in mandibular extension of head and neck squamous cell carcinoma with dedicated analysis software and validation with surgical specimen. A preliminary study. J Craniomaxillofac Surg 2017; 45:1486-1492. [PMID: 28764952 DOI: 10.1016/j.jcms.2017.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/08/2017] [Accepted: 06/30/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this study is to propose a new method to quantify radioactivity with PET/CT imaging in mandibular extension in head and neck squamous cell carcinoma (HNSCC), using innovative software, and to compare results with microscopic surgical specimens. PATIENTS AND METHODS This prospective study enrolled 15 patients who underwent 18F-NaF and 18F-FDG PET/CT. We compared the delineations of bone invasions obtained with 18F-NaF PET/CT and 18F-FDG PET/CT with the results of histopathological analysis of mandibular resections (from right and left bone borders). A method for visualization and quantification of PET images was developed. RESULTS For all patients, a significant difference (p = 0.032 for right limits and p = 0.011 for left limits) was observed between 18F-FDG PET/CT imaging and histopathology results, and no significant difference (p = 0.88 for right limits and p = 0.55 for left limits) was observed between 18F-NaF PET/CT imaging and histopathology results. The right limits were less than 10 mm in 93% of patients, and the left limits were less than 10 mm in 86% of patients. CONCLUSIONS The dedicated software enabled the objective delineation of radioactivity within the bone. We can confirm that 18F-NaF is a precise and specific bone marker for the assessment of intraosseous mandibular extensions of head and neck cancers. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Raphael Lopez
- University of Toulouse, UPS, F-31062 Toulouse Cedex 04, France; Toulouse NeuroImaging Center, ToNIC, UMR 1214, F-31059 Toulouse, France; Plastic and Maxillo-facial Surgery Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France.
| | - Pierre Gantet
- University of Toulouse, UPS, F-31062 Toulouse Cedex 04, France; Nuclear Medicine Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Anne Sophie Salabert
- University of Toulouse, UPS, F-31062 Toulouse Cedex 04, France; Toulouse NeuroImaging Center, ToNIC, UMR 1214, F-31059 Toulouse, France; Radiopharmacy Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Anne Julian
- Nuclear Medicine Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Anne Hitzel
- University of Toulouse, UPS, F-31062 Toulouse Cedex 04, France; Nuclear Medicine Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Beatrice Herbault-Barres
- Anatomopathology Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Charlotte Fontan
- University of Toulouse, UPS, F-31062 Toulouse Cedex 04, France; Toulouse NeuroImaging Center, ToNIC, UMR 1214, F-31059 Toulouse, France; Radiopharmacy Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Sarah Alshehri
- Otolaryngology Department, King Khalid University, College of Medicine, Saudi Arabia
| | - Pierre Payoux
- University of Toulouse, UPS, F-31062 Toulouse Cedex 04, France; Toulouse NeuroImaging Center, ToNIC, UMR 1214, F-31059 Toulouse, France; Nuclear Medicine Department, Pierre Paul Riquet Hospital, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| |
Collapse
|
17
|
Hu KS, Mourad WF, Gamez M, Safdieh J, Lin W, Jacobson AS, Persky MS, Urken ML, Culliney B, Li Z, Tran TN, Schantz SP, Chadha J, Harrison LB. Low rates of contralateral neck failure in unilaterally treated oropharyngeal squamous cell carcinoma with prospectively defined criteria of lateralization. Head Neck 2017; 39:1647-1654. [DOI: 10.1002/hed.24806] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kenneth Shung Hu
- Department of Radiation Oncology; New York University Langone Medical Center; New York New York
| | - Waleed Fouad Mourad
- Department of Radiation Oncology; Georgia Regents University; Augusta Georgia
| | - Mauricio Gamez
- Department of Radiation Oncology; Mayo Clinic; Scottsdale Arizona
| | - Joseph Safdieh
- Department of Radiation Oncology; Mount Sinai at Beth Israel Medical Center; New York New York
| | - Wilson Lin
- Department of Radiation Oncology; Mount Sinai at Beth Israel Medical Center; New York New York
| | - Adam Saul Jacobson
- Department of Otolaryngology; New York University Langone Medical Center; New York New York
| | - Mark Stephen Persky
- Department of Otolaryngology; New York University Langone Medical Center; New York New York
| | | | - Bruce Culliney
- Department of Medicine; Mount Sinai at Beth Israel; New York New York
| | - Zujun Li
- Department of Medicine; New York University Langone Medical Center; New York New York
| | - Theresa Nguyen Tran
- Department of Otolaryngology; New York University Langone Medical Center; New York New York
| | | | - Juskaran Chadha
- Department of Medicine; Mount Sinai at Roosevelt Hospital; New York New York
| | | |
Collapse
|
18
|
Choi N, Noh Y, Lee EK, Chung M, Baek CH, Baek KH, Jeong HS. Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance. J Surg Oncol 2017; 115:1011-1018. [DOI: 10.1002/jso.24606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/16/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Yangseop Noh
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Eun Kyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Manki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Kwan-Hyuck Baek
- Department of Molecular and Cellular Biology; Samsung Biomedical Research Institute; Sungkyunkwan University School of Medicine; Suwon Republic of Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Cacicedo J, Navarro A, Del Hoyo O, Gomez-Iturriaga A, Alongi F, Medina JA, Elicin O, Skanjeti A, Giammarile F, Bilbao P, Casquero F, de Bari B, Dal Pra A. Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol 2016; 89:20160217. [PMID: 27416996 DOI: 10.1259/bjr.20160217] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT (18F-FDG-PET/CT) rapidly gained clinical acceptance, and it has become an important imaging tool in routine clinical oncology. However, controversial data are currently available, for example, on the role of 18F-FDG-PET/CT imaging during radiotherapy planning, the prognostic value or its real clinical impact on treatment decisions. In this article, the role of 18F-FDG-PET/CT imaging in HNSCC during pre-treatment staging, radiotherapy planning, treatment response assessment, prognosis and follow-up is reviewed focusing on current evidence and controversial issues. A proposal on how to integrate 18F-FDG-PET/CT in daily clinical practice is also described.
Collapse
Affiliation(s)
- Jon Cacicedo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain.,2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC)
| | - Arturo Navarro
- 3 Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Del Hoyo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Alfonso Gomez-Iturriaga
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Filippo Alongi
- 4 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Jose A Medina
- 2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC).,5 Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Olgun Elicin
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Skanjeti
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Francesco Giammarile
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pedro Bilbao
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Francisco Casquero
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Berardino de Bari
- 8 fESTRO Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Alan Dal Pra
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
21
|
Lee M, Ramaswamy MR, Lilien DL, Nathan CAO. Unilateral Vocal Cord Paralysis Causes Contralateral False-Positive Positron Emission Tomography Scans of the Larynx. Ann Otol Rhinol Laryngol 2016; 114:202-6. [PMID: 15825569 DOI: 10.1177/000348940511400306] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Positron emission tomography (PET) is used in the management of head and neck cancers. It identifies tissue with increased metabolic activity and is not specific for malignancy. A false-positive PET scan of the larynx is associated with vocal cord paralysis. We reviewed PET scan reports of patients with lung cancer from 1998 to 2001 to identify patients with increased 18-fluoro-2-deoxyglucose uptake in the larynx without a known history of head and neck cancer and then correlated this increased uptake with laryngoscopic findings. There were 17 patients who had a positive PET finding in the larynx. Fifteen of those had a false-positive PET scan in the larynx. All had contralateral vocal cord paralysis. Two patients were noted to have head and neck cancer. We conclude that vocal cord paralysis can cause a false-positive PET scan on the contralateral side of the larynx due to overactivity of laryngeal muscles that compensate for the paralyzed cord.
Collapse
Affiliation(s)
- Michael Lee
- Department of Otolaryngology, Louisiana State University-Health Sciences Center, Shreveport, Louisiana 71130-3932, USA
| | | | | | | |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Differentiation of benign from malignant cervical lymph nodes in patients with head and neck cancer using PET/CT imaging. Clin Imaging 2015; 40:101-5. [PMID: 26454617 DOI: 10.1016/j.clinimag.2015.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/16/2015] [Accepted: 09/01/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE To differentiate malignant from benign cervical lymph nodes in patients with head/neck cancer. METHODS In this retrospective study, 39 patients with primary head/neck cancer who underwent Positron Emission Tomography (PET)/Computerized Tomography (CT) and image-guided lymph node biopsy were included. RESULTS Overall, 23 (59%) patients had biopsy-proven malignant cervical lymphadenopathy. Malignant lymph nodes had higher maximum standardized uptake (SUV-max) value (P<.001) and short-axis diameter (P=.015) compared to benign nodes. An SUV-max of ≥2.5 was 100% sensitive, and an SUV-max ≥5.5 was 100% specific for malignant lymphadenopathy. CONCLUSION The PET/CT SUV-max value can help with differentiation of malignant cervical lymph nodes in patients with head/neck cancer.
Collapse
|
24
|
Dual-phase F-18 FDG PET–CT in staging and lymphoscintigraphy for detection of sentinel lymph nodes in oral cavity cancers. Clin Imaging 2015; 39:781-6. [DOI: 10.1016/j.clinimag.2015.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 02/03/2015] [Accepted: 02/06/2015] [Indexed: 01/17/2023]
|
25
|
FDG PET/CT for Management and Assessing Outcomes of Squamous Cell Cancer of the Oral Cavity. AJR Am J Roentgenol 2015; 205:W150-61. [DOI: 10.2214/ajr.14.13830] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
26
|
Sun J, Li B, Li CJ, Li Y, Su F, Gao QH, Wu FL, Yu T, Wu L, Li LJ. Computed tomography versus magnetic resonance imaging for diagnosing cervical lymph node metastasis of head and neck cancer: a systematic review and meta-analysis. Onco Targets Ther 2015; 8:1291-313. [PMID: 26089682 PMCID: PMC4467645 DOI: 10.2147/ott.s73924] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) are common imaging methods to detect cervical lymph node metastasis of head and neck cancer. We aimed to assess the diagnostic efficacy of CT and MRI in detecting cervical lymph node metastasis, and to establish unified diagnostic criteria via systematic review and meta-analysis. A systematic literature search in five databases until January 2014 was carried out. All retrieved studies were reviewed and eligible studies were qualitatively summarized. Besides pooling the sensitivity (SEN) and specificity (SPE) data of CT and MRI, summary receiver operating characteristic curves were generated. A total of 63 studies including 3,029 participants were involved. The pooled results of meta-analysis showed that CT had a higher SEN (0.77 [95% confidence interval {CI} 0.73–0.87]) than MRI (0.72 [95% CI 0.70–0.74]) when node was considered as unit of analysis (P<0.05); MRI had a higher SPE (0.81 [95% CI 0.80–0.82]) than CT (0.72 [95% CI 0.69–0.74]) when neck level was considered as unit of analysis (P<0.05) and MRI had a higher area under concentration-time curve than CT when the patient was considered as unit of analysis (P<0.05). With regards to diagnostic criteria, for MRI, the results showed that the minimal axial diameter of 10 mm could be considered as the best size criterion, compared to 12 mm for CT. Overall, MRI conferred significantly higher SPE while CT demonstrated higher SEN. The diagnostic criteria for MRI and CT on size of metastatic lymph nodes were suggested as 10 and 12 mm, respectively.
Collapse
Affiliation(s)
- J Sun
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People's Republic of China
| | - B Li
- West China School of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People's Republic of China
| | - C J Li
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People's Republic of China
| | - Y Li
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People's Republic of China
| | - F Su
- Department of stomatology, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Q H Gao
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - F L Wu
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - T Yu
- Department of Head and Neck Oncology Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China
| | - L Wu
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - L J Li
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, People's Republic of China
| |
Collapse
|
27
|
Choi HJ, Lee KH, Kim NH, Kim JH, Hyun IY, Ryu JS. The usefulness of combined axial and coronal computed tomography for the evaluation of metastatic supraclavicular lymph nodes. Clin Imaging 2015; 39:608-12. [PMID: 25940644 DOI: 10.1016/j.clinimag.2015.04.008] [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: 02/11/2015] [Accepted: 04/10/2015] [Indexed: 12/18/2022]
Abstract
The purpose is to assess the value of adding coronal images for the identification of metastatic supraclavicular lymph nodes (LNs). Two radiologists reviewed axial images and combined axial and coronal images using thoracic computed tomography (CT) of 386 patients whose maximum standardized uptake value measured in a supraclavicular LN was ≥2.0 on a positron emission tomography. We compared sensitivity and agreement between readers before and after the addition of coronal images. For combined images, agreement was almost perfect (κ=0.982), and sensitivity was significantly higher (90.4%, P<.001). Interpreting both axial and coronal images improves the diagnostic accuracy for supraclavicular metastasis.
Collapse
Affiliation(s)
- Hyun Jin Choi
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Kyung Hee Lee
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Na Hee Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Jun Ho Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea.
| | - In Young Hyun
- Department of Nuclear Medicine, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Jeong-Seon Ryu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| |
Collapse
|
28
|
Nair S, Mohan S, Nilakantan A, Gupta A, Malik A, Gupta A. Impact of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography scan on initial evaluation of head and neck squamous cell carcinoma: our experience at a tertiary care center in India. World J Nucl Med 2015; 14:19-24. [PMID: 25709540 PMCID: PMC4337002 DOI: 10.4103/1450-1147.150519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The efficacy of the whole body (WB) 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) as a part of conventional initial staging in all cases of head and neck squamous cell carcinoma (HNSCC) is still controversial with various studies in literature giving contradictory reports. We conducted this study at a government tertiary care oncology center in India to identify the impact of WB 18F-FDG PET-CT scan on HNSCC staging and treatment. A prospective clinical study of patients of HNSCC who were evaluated and treated at our center was performed. The patients included in the study were HNSCC of the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, and carcinoma of unknown primary site (CUPS) with cervical metastasis. The study design was to evaluate the cases of HNSCC initially by staging with conventional investigations followed by staging with the information derived from WB 18F-FDG PET-CT scan. At the end of the conventional investigations, a tumor, node, metastasis (TNM) staging as per AJCC 7th edition, and a detailed treatment plan as per NCCN 2012 guidelines was decided in consultation with the multidisciplinary oncology team of the hospital. WB 18F-FDG PET-CT scan was carried out in all these patients. The findings of WB 18F-FDG PET-CT were then interpreted with the staging with conventional investigations to identify the cases with change in staging and also those in whom the treatment protocol would be affected. Descriptive analysis of demographic data and analytical analysis of the sensitivity and specificity of WB 18F-FDG PET-CT scan and also the change in staging and treatment plan after WB 18F-FDG PET-CT scan was analyzed using SPSS version 18. A total of 131 patients met the inclusion criteria, which included 123 males and 8 females. The various sites involved among the study group are oral cavity 11 (8.3%), oropharyn × 39 (29.7%), hypopharyn × 31 (23.6%), laryn × 34 (25.9%), nasopharyn × 4 (3%), and CUPS 12 (9.1%). The majority of cases studied were of T2 and T3 stage, and changes in T staging after WB 18F-FDG PET-CT scan were minimal and not statistically significant (P > 0.5). In the nodal staging after WB 18F-FDG PET-CT scan, there was a statistically significant change in identification of nodal metastasis in N0 group and also identification of additional multiple/bilateral nodes (N2b and N2c). 3 (2.2%) patients had a change in M status with identification of distant metastasis in lungs (2 patients) and in the liver and lung (1 patient). Of the 131 patients, 75 (57.25%) underwent surgical management with or without adjuvant treatment (Group I) and 56 (42.74%) patients underwent nonsurgical management (Group II). There was no significant statistical difference in sensitivity and specificity of 18F-FDG PET-CT scan in detecting cancer among the two groups. Considering all the patients in this study, WB 18F-FDG PET-CT scan showed an overall sensitivity of 95.2% and specificity of 80%. In this study, change in TNM staging after WB 18F-FDG PET-CT was seen in 22 (16.8%) patients and an alteration in the treatment in 21 (16.1%) patients, which were both found to be statistically significant (P < 0.5). In our study, WB 18F-FDG PET-CT scan has shown to have an impact on initial staging of disease affecting the change in treatment protocol in a significant number of patients. The effect of this change in staging and treatment on the eventual morbidity and mortality rates is not known. In practice, the use of 18F-FDG PET-CT scan is limited, owing to the high cost and low availability. A realistic evaluation of cost versus benefit needs to be undertaken to identify the impact of using 18F-FDG PET-CT scan as a mode for initial evaluation of HNSCC.
Collapse
Affiliation(s)
- Satish Nair
- Department of ENT, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| | - Sharad Mohan
- Department of Otolaryngology and Head and Neck Surgery, Army Hospital, Research and Referral, Delhi Cantonment, New Delhi, India
| | - Ajith Nilakantan
- Department of ENT, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| | - Atul Gupta
- Department of ENT, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| | - Akshat Malik
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Gupta
- Department of ENT, Army Hospital Research and Referral, Delhi Cantonment, New Delhi, India
| |
Collapse
|
29
|
Chaukar D, Dandekar M, Kane S, Arya S, Purandare N, Rangarajan V, Deshmukh A, Pai P, Chaturvedi P, D'Cruz A. Relative value of ultrasound, computed tomography and positron emission tomography imaging in the clinically node-negative neck in oral cancer. Asia Pac J Clin Oncol 2014; 12:e332-8. [DOI: 10.1111/ajco.12255] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Devendra Chaukar
- Department of Head and Neck Surgery; Tata Memorial Hospital; Mumbai India
| | - Mitali Dandekar
- Department of Head and Neck Surgery; Tata Memorial Hospital; Mumbai India
| | - Shubhada Kane
- Department of Pathology; Tata Memorial Hospital; Mumbai India
| | - Supreeta Arya
- Department of Radiology; Tata Memorial Hospital; Mumbai India
| | | | | | - Anuja Deshmukh
- Department of Head and Neck Surgery; Tata Memorial Hospital; Mumbai India
| | - Prathamesh Pai
- Department of Head and Neck Surgery; Tata Memorial Hospital; Mumbai India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery; Tata Memorial Hospital; Mumbai India
| | - Anil D'Cruz
- Department of Head and Neck Surgery; Tata Memorial Hospital; Mumbai India
| |
Collapse
|
30
|
FDG PET/MR for lymph node staging in head and neck cancer. Eur J Radiol 2014; 83:1163-1168. [DOI: 10.1016/j.ejrad.2014.03.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/21/2022]
|
31
|
The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. BIOMED RESEARCH INTERNATIONAL 2014; 2014:532095. [PMID: 25003115 PMCID: PMC4070473 DOI: 10.1155/2014/532095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/18/2014] [Accepted: 05/18/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of this study was to validate the role of diffusion-weighted imaging (DWI) at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se) and specificity (Spe) of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference. RESULTS In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC) value was 0.903 × 10(-3) mm(2)/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10(-3) mm(2)/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC) of 0.964, while morphological criteria displayed an AUC of 0.715. CONCLUSIONS In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection.
Collapse
|
32
|
Ramos M, Benavente S, Giralt J. Management of squamous cell carcinoma of the head and neck: updated European treatment recommendations. Expert Rev Anticancer Ther 2014; 10:339-44. [DOI: 10.1586/era.10.6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
33
|
Chin D, Boyle GM, Porceddu S, Theile DR, Parsons PG, Coman WB. Head and neck cancer: past, present and future. Expert Rev Anticancer Ther 2014; 6:1111-8. [PMID: 16831082 DOI: 10.1586/14737140.6.7.1111] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Head and neck cancer consists of a diverse group of cancers that ranges from cutaneous, lip, salivary glands, sinuses, oral cavity, pharynx and larynx. Each group dictates different management. In this review, the primary focus is on head and neck squamous cell carcinoma (HNSCC) arising from the mucosal lining of the oral cavity and pharynx, excluding nasopharyngeal cancer. Presently, HNSCC is the sixth most prevalent neoplasm in the world, with approximately 900,000 cases diagnosed worldwide. Prognosis has improved little in the past 30 years. In those who have survived, pain, disfigurement and physical disability from treatment have had an enormous psychosocial impact on their lives. Management of these patients remains a challenge, especially in developing countries where this disease is most common. Of all human cancers, HNSCC is the most distressing since the head and neck is the site of the most complex functional anatomy in the human body. Its areas of responsibility include breathing, the CNS, vision, hearing, balance, olfaction, taste, swallowing, voice, endocrine and cosmesis. Cancers that occur in this area impact on these important human functions. Consequently, in treating cancers of the head and neck, the effects of the treatment on the functional outcome of the patient need the most serious consideration. In assessing the success of HNSCC treatment, consideration of both the survival and functional deficits that the patient may suffer as a consequence of their treatment are of paramount importance. For this reason, the modern-day management of head and neck patients should be carried out in a multidisciplinary head and neck clinic.
Collapse
Affiliation(s)
- David Chin
- Department of Plastic Surgery and Head & Neck Unit, Princess Alexandra Hospital, Brisbane 4102, Queensland, Australia.
| | | | | | | | | | | |
Collapse
|
34
|
Hanamoto A, Takenaka Y, Shimosegawa E, Ymamamoto Y, Yoshii T, Nakahara S, Hatazawa J, Inohara H. Limitation of 2-deoxy-2-[F-18]fluoro-d-glucose positron emission tomography (FDG-PET) to detect early synchronous primary cancers in patients with untreated head and neck squamous cell cancer. Ann Nucl Med 2013; 27:880-5. [DOI: 10.1007/s12149-013-0765-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/14/2013] [Indexed: 12/22/2022]
|
35
|
Bryson TC, Shah GV, Srinivasan A, Mukherji SK. Cervical lymph node evaluation and diagnosis. Otolaryngol Clin North Am 2013; 45:1363-83. [PMID: 23153753 DOI: 10.1016/j.otc.2012.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article discusses the rationale for imaging cervical lymph nodes and reviews nodal anatomy and common drainage patterns, imaging features of pathologic lymph nodes, and the advantages of various imaging modalities available for evaluation and diagnosis of the lymph nodes.
Collapse
Affiliation(s)
- Thomas C Bryson
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI 48109-5030, USA
| | | | | | | |
Collapse
|
36
|
Hoshikawa H, Kishino T, Mori T, Nishiyama Y, Yamamoto Y, Inamoto R, Akiyama K, Mori N. Comparison of ( 18 ) F-FLT PET and ( 18 ) F-FDG PET for detection of cervical lymph node metastases in head and neck cancers. Acta Otolaryngol 2012; 132:1347-54. [PMID: 22992199 DOI: 10.3109/00016489.2012.709319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Despite low uptake of tracer, 3'-deoxy-3'-(18)F-fluorothymidine (FLT) PET could detect cervical lymph node metastases as well as 2-deoxy-2-(18)F-fluoro-d-glucose (FDG) PET. OBJECTIVE The diagnostic efficacy of FLT PET was compared with that of FDG PET regarding nodal staging of head and neck squamous cell cancers. METHODS Twenty-three patients were examined with FLT PET and FDG PET. PET images were evaluated qualitatively for regions of focally increased metabolism and maximum standardized uptake values (SUV) were calculated for semiquantitative analysis. RESULTS The mean (± SD) FLT SUV in visualized metastatic lymph nodes was 4.8 ± 2.9 as compared with 6.9 ± 4.9 for FDG SUV (p < 0.001). Significant correlations were found between the area of metastatic lymph nodes and both FLT SUV (r = 0.8; p < 0.0001) and FDG SUV (r = 0.84; p < 0.0001). The false-positive (over-staged) and false-negative (under-staged) rates for lymph node staging by FLT PET were 4% (1/23) and 17% (4/23), respectively. Those for FDG PET were 9% (2/23) and 13% (3/23). All metastatic lymph nodes measuring more than 9 mm in short-axis diameter were correctly detected by FLT PET. However, both FLT and FDG PET had low sensitivity for detecting the lymph node metastases ≤ 9 mm in short-axis diameter and tumor deposits < 5 mm.
Collapse
Affiliation(s)
- Hiroshi Hoshikawa
- Departments of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Kim MJ, Kim JS, Roh JL, Lee JH, Cho KJ, Choi SH, Nam SY, Kim SY. Utility of 18F-FDG PET/CT for Detecting Neck Metastasis in Patients with Salivary Gland Carcinomas: Preoperative Planning for Necessity and Extent of Neck Dissection. Ann Surg Oncol 2012; 20:899-905. [DOI: 10.1245/s10434-012-2716-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Indexed: 11/18/2022]
|
38
|
Platzek I, Beuthien-Baumann B, Schneider M, Gudziol V, Langner J, Schramm G, Laniado M, Kotzerke J, van den Hoff J. PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging 2012; 40:6-11. [PMID: 23053322 PMCID: PMC3510405 DOI: 10.1007/s00259-012-2248-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/03/2012] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate the feasibility of PET/MRI (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for initial staging of head and neck cancer. Methods The study group comprised 20 patients (16 men, 4 women) aged between 52 and 81 years (median 64 years) with histologically proven squamous cell carcinoma of the head and neck region. The patients underwent a PET scan on a conventional scanner and a subsequent PET/MRI examination on a whole-body hybrid system. FDG was administered intravenously prior to the conventional PET scan (267–395 MBq FDG, 348 MBq on average). The maximum standardized uptake values (SUVmax) of the tumour and of both cerebellar hemispheres were determined for both PET datasets. The numbers of lymph nodes with increased FDG uptake were compared between the two PET datasets. Results No MRI-induced artefacts where observed in the PET images. The tumour was detected by PET/MRI in 17 of the 20 patients, by PET in 16 and by MRI in 14. The PET/MRI examination yielded significantly higher SUVmax than the conventional PET scanner for both the tumour (p < 0.0001) and the cerebellum (p = 0.0009). The number of lymph nodes with increased FDG uptake detected using the PET dataset from the PET/MRI system was significantly higher the number detected by the stand-alone PET system (64 vs. 39, p = 0.001). Conclusion The current study demonstrated that PET/MRI of the whole head and neck region is feasible with a whole-body PET/MRI system without impairment of PET or MR image quality.
Collapse
Affiliation(s)
- Ivan Platzek
- Department of Radiology, Dresden University Hospital, Fetscherstrasse 74, Dresden, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
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.
Collapse
|
40
|
Spector ME, Chinn SB, Rosko AJ, Worden FP, Ward PD, Divi V, McLean SA, Moyer JS, Prince MEP, Wolf GT, Chepeha DB, Bradford CR. Diagnostic modalities for distant metastasis in head and neck squamous cell carcinoma: are we changing life expectancy? Laryngoscope 2012; 122:1507-11. [PMID: 22460441 DOI: 10.1002/lary.23264] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 02/02/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if the various imaging modalities for distant metastasis (DM) diagnosis alters life expectancy in head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN Retrospective. METHODS One hundred seventy patients (mean age, 59.1 years; male:female, 135:35) with HNSCC who developed DM were reviewed. The main outcome measures were the method of DM diagnosis and time from DM diagnosis to death while controlling for clinical parameters (age, gender, tobacco status, primary tumor site, initial TNM classification, number and site of DM, administration of palliative chemotherapy). RESULTS Tumor subsites were: 40 oral cavity, 75 oropharynx, 36 larynx, 10 hypopharynx, one nasopharynx, and eight unknown primary. Of the patients, 16.5% (28/170) had distant metastasis at presentation; the remaining 142 patients were diagnosed with DM at a median of 324 days from diagnosis. Although patients diagnosed with DM by positron-emission tomography (PET) scan were more likely to have multiple DM sites (P = .0001), there were no differences in life expectancy in patients who were diagnosed with or without PET scan (median, 185 vs. 165 days, P = .833). There were no differences in life expectancy based on age, gender, site of primary tumor, or number/site of DM. The use of palliative chemotherapy resulted in a significantly longer life expectancy (median, 285 vs. 70 days; P = .001). CONCLUSIONS Although a PET scan is more likely to diagnose multiple DM sites, there was no difference in life expectancy based on imaging modality. Patients who are symptomatic from their distant metastasis have a worse life expectancy, and palliative chemotherapy was able to increase life expectancy, even in patients who were symptomatic from the distant metastasis.
Collapse
Affiliation(s)
- Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Van Abel KM, Moore EJ. Focus issue: neck dissection for oropharyngeal squamous cell carcinoma. ISRN SURGERY 2012; 2012:547017. [PMID: 22586518 PMCID: PMC3265121 DOI: 10.5402/2012/547017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 11/21/2011] [Indexed: 11/23/2022]
Abstract
The staging and prognosis of oropharyngeal squamous cell carcinoma is intimately tied to the status of the cervical lymph nodes. Due to the high risk for occult nodal disease, most clinicians recommend treating the neck for these primary tumors. While there are many modalities available, surgical resection of nodal disease offers both a therapeutic and a diagnostic intervention. We review the relevant anatomy, nodal drainage patterns, clinical workup, surgical management and common complications associated with neck dissection for oropharyngeal squamous cell carcinoma.
Collapse
Affiliation(s)
- Kathryn M. Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Eric J. Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
42
|
Delouya G, Igidbashian L, Houle A, Bélair M, Boucher L, Cohade C, Beaulieu S, Filion EJ, Coulombe G, Hinse M, Martel C, Després P, Nguyen-Tan PF. ¹⁸F-FDG-PET imaging in radiotherapy tumor volume delineation in treatment of head and neck cancer. Radiother Oncol 2011; 101:362-8. [PMID: 21885143 DOI: 10.1016/j.radonc.2011.07.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 06/29/2011] [Accepted: 07/13/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the impact of (18)F-fluorodeoxyglucose positron emission tomography (PET) in radiotherapy target delineation and patient management for head and neck squamous cell carcinoma (HNSCC) compared to computed tomography (CT) alone. MATERIALS AND METHODS Twenty-nine patients with HNSCC were included. CT and PET/CT obtained for treatment planning purposes were reviewed respectively by a neuroradiologist and a nuclear medicine specialist who were blinded to the findings from each other. The attending radiation oncologist together with the neuroradiologist initially defined all gross tumor volume of the primary (GTVp) and the suspicious lymph nodes (GTVn) on CT. Subsequently, the same radiation oncologist and the nuclear medicine specialist defined the GTVp and GTVn on (18)F-FDG-PET/CT. Upon disagreement between CT and (18)F-FDG-PET on the status of a particular lymph node, an ultrasound-guided fine needle aspiration was performed. Volumes based on CT and (18)F-FDG-PET were compared with a paired Student's t-test. RESULTS For the primary disease, four patients had previous diagnostic tonsillectomy and therefore, FDG uptake occurred in 25 patients. For these patients, GTVp contoured on (18)F-FDG-PET (GTVp-PET) were smaller than the GTVp contoured on CT (GTVp-CT) in 80% of the cases, leading to a statistically significant volume difference (p=0.001). Of the 60 lymph nodes suspicious on PET, 55 were also detected on CT. No volume change was observed (p=0.08). Ten biopsies were performed for lymph nodes that were discordant between modalities and all were of benign histology. Distant metastases were found in two patients and one had a newly diagnosed lung adenocarcinoma. CONCLUSIONS GTVp-CT was significantly larger when compared to GTVp-PET. No such change was observed for the lymph nodes. (18)F-FDG-PET modified treatment management in three patients, including two for which no curative radiotherapy was attempted. Larger multicenter studies are needed to ascertain whether combined (18)F-FDG-PET/CT in target delineation can influence the main clinical outcomes.
Collapse
Affiliation(s)
- Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Chu MMAY, Kositwattanarerk A, Lee DJ, Makkar JS, Genden EM, Kao J, Packer SH, Som PM, Kostakoglu L. FDG PET with contrast-enhanced CT: a critical imaging tool for laryngeal carcinoma. Radiographics 2011; 30:1353-72. [PMID: 20833855 DOI: 10.1148/rg.305095764] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has evolved to be an essential imaging modality in the evaluation of laryngeal carcinoma. Although the modality has limited utility in assessing the extent of the primary tumor, FDG PET has proved to be superior to anatomic modalities in the detection of lymph node and distant metastases. The role of FDG PET in the evaluation of patients with laryngeal tumors that are clinically classified as N0 has not shown consistent usefulness because of the innate resolution limitations of the camera. In the posttherapy setting, however, FDG PET has consistently demonstrated a high negative predictive value in the identification of recurrent disease, both during the course of therapy and during long-term follow-up. In addition, contrast material-enhanced computed tomography (CT) in conjunction with FDG PET has demonstrated a complementary role by allowing for superior anatomic coregistration and therefore more definitive diagnosis. There is sufficient evidence that with further advances in PET technology, this modality will likely become more useful in the detection of small lesions and occult nodal disease, as well as in guiding the management of laryngeal carcinoma.
Collapse
Affiliation(s)
- Mae Mae A Y Chu
- Department of Radiology, Mount Sinai Medical Center, New York, NY 10029, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Functional imaging using radiolabeled probes that specifically bind and accumulate in target tissues has improved the sensitivity and specificity of conventional imaging. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) has shown improved diagnostic accuracy in differentiating benign from malignant lesions in the setting of solitary pulmonary nodules. FDG-PET has become useful in preoperative staging of patients with lung cancer, and is being tested with many other malignancies for its ability to change patient management. This article provides an overview of the current status of FDG-PET and presents the challenges of moving toward routine use.
Collapse
|
45
|
Abstract
In initial staging of head and neck cancers, the addition of FDG PET to conventional imaging improves the accuracy for cervical nodal metastases. The sensitivity of FDG PET is, however, limited in nodes <1 cm and in completely necrotic nodes. In the posttherapy setting, PET scans obtained at least 10 weeks after radiotherapy have an excellent predictive value to rule out residual disease. Due to the limited positive predictive value of FDG PET after radiation therapy, a positive PET scan needs to be confirmed before management decisions are made.
Collapse
Affiliation(s)
- Yusuf Menda
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | | |
Collapse
|
46
|
Richard C, Prevot N, Timoshenko AP, Dumollard JM, Dubois F, Martin C, Prades JM. Preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography imaging in head and neck cancer: does it really improve initial N staging? Acta Otolaryngol 2010; 130:1421-4. [PMID: 20735322 DOI: 10.3109/00016489.2010.502183] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION In our experience PET-CT cannot yet reliably predict the need for surgical neck dissection in patients with N0 neck. According to the results of PET-CT the neck dissection should be extended towards unusual lymph node areas. OBJECTIVE To analyze the value of PET-CT for the initial N staging, comparing PET-CT data with histopathological results of the modified radical neck dissection. METHODS Fifty patients with previously untreated head and neck squamous cell carcinoma were eligible for inclusion in this study. Modified radical unilateral or bilateral neck dissection was performed in all patients. PET-CT findings and histological findings were compared to determine their diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. RESULTS In all, 105 levels had pathologically diagnosed metastases: PET-CT was positive in 87 levels and negative in 18 levels. Also, 399 levels had negative postoperative histology findings: PET-CT was positive in 24 levels and negative in 375 levels. The false-positive over-staged and the false-negative under-staged rates were 27% and 12%, respectively.
Collapse
Affiliation(s)
- Celine Richard
- Department of Otolaryngology - Head and Neck Surgery, North Hospital, University Hospital Centre, Saint-Etienne, France
| | | | | | | | | | | | | |
Collapse
|
47
|
Kubicek GJ, Champ C, Fogh S, Wang F, Reddy E, Intenzo C, Dusing RW, Machtay M. FDG-PET staging and importance of lymph node SUV in head and neck cancer. HEAD & NECK ONCOLOGY 2010; 2:19. [PMID: 20637102 PMCID: PMC2915991 DOI: 10.1186/1758-3284-2-19] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 07/16/2010] [Indexed: 12/11/2022]
Abstract
Objectives The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC. Methods Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on to receive radiotherapy. Results The median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p < 0.0007). Maximum SUV for the primary tumor > 8.0 was predictive of worse overall survival (p < 0.045), while the SUV of the lymph nodes was predictive for distant recurrence at one year--with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p < 0.05). Conclusions FDG-PET staging in head and neck cancer has good positive and negative predictive values in determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the first report to find that the SUV of a lymph node is predictive for ECE and also for distant recurrence.
Collapse
|
48
|
Bellón Guardia ME, Pérez Romasanta L, García Vicente AM, Talavera Rubio MP, Palomar Muñoz A, González García B, Poblete García VM, Soriano Castrejón A. [Utility of PET-CT on radiotherapy planning of head and neck cancer. Our initial experience]. ACTA ACUST UNITED AC 2010; 29:157-64. [PMID: 20494489 DOI: 10.1016/j.remn.2010.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 03/09/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the methods used for the incorporation of FDG-PET-CT on radiotherapy planning of patients with head and neck cancer and also to evaluate the impact of FDG-PET-CT on staging and tumor volume definition. MATERIAL AND METHODS A prospective study in which 20 patients with head and neck tumor submitted for radiotherapy treatment were included. All underwent a whole body PET- CT (GE DSTE 16) for staging and restaging, also acquiring an additional 3h delayed PET image with diagnostic CT parameters for planning. A CT scan with diagnostic protocol, tabletop available for radiotherapy treatment and the same personalized head-shoulder mask were used in the latter. Lymph node involvement and/or distant involvement were evaluated, considering the changes in staging. We also evaluated the differences in volumes obtained between the different techniques. The threshold value used for delineating PET gross tumor volume (GTV) was empirically established and ranged from 20-40% of the maximum SUV. RESULTS Radiotherapy planning was performed with PET-CT in 20 patients between October 2007 to September 2008. A total of 29 lesions (18 primary lesions because 2 patients were excluded as no tumor was observed on the PET CT images, and 11 nodes). The most frequent location was oropharynx (5 patients). Mean maxSUV of the 29 lesions was 14.4 (range 5.0 and 26.4). No statistically significant differences were found between the GTV PET and GTV CT (mean 21.9cm³ and 19.3cm³, respectively). PET-CT modified the staging in 20% of the patients, with a diagnostic and therapeutic impact of 50 and 25%, respectively. CONCLUSION The incorporation of PET-CT in routine radiotherapy planning is a promising technique that requires close collaboration between the nuclear medicine and radiotherapy oncology departments. PET-CT achieves better staging in patients and has a significant diagnostic and therapeutic impact. The use of the hybrid technique avoids problems arising from co-registry as well as a second examination for planning with the consequent advantage for the patient. Nonetheless, more prospective and randomized studies with pathology specimens are needed to evaluate the real impact in the tumor volume definition.
Collapse
Affiliation(s)
- M E Bellón Guardia
- Servicio de Medicina Nuclear, Hospital General de Ciudad Real, Ciudad Real, España.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Simons AL, Mattson DM, Dornfeld K, Spitz DR. Glucose deprivation-induced metabolic oxidative stress and cancer therapy. J Cancer Res Ther 2010; 5 Suppl 1:S2-6. [PMID: 20009288 DOI: 10.4103/0973-1482.55133] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cancer cells (vs. normal cells) demonstrate evidence of oxidative stress, increased glycolysis, and increased pentose cycle activity. The oxidative stress in cancer cells has been hypothesized to arise from mitochondrial dysfunction leading to increased levels of hydroperoxides, and cancer cells have been proposed to compensate for this defect by increasing glucose metabolism. Glucose metabolism has also been shown to play a role in hydroperoxide detoxification via the formation of pyruvate (from glycolysis) and NADPH (from the pentose cycle). Furthermore, in cancer cells, glucose deprivation as well as treatment with 2-deoxyglucose (2 DG) has been shown to induce oxidative stress and cytotoxicity. Additionally, transformed cells have been shown to be more susceptible to glucose deprivation (and 2DG-)-induced cytotoxicity and oxidative stress than untransformed cells. These results support the hypothesis that cancer cells have a defect in mitochondrial respiration leading to increased steady state levels of O2*- and H2O2, and glucose metabolism is increased to compensate for this defect. The application of these findings to developing cancer therapies using 2DG combined with inhibitors of hydroperoxide metabolism to induce radio/chemosensitization is discussed, as well as the possibility that FDG-PET imaging may predict tumor responses to these therapies.
Collapse
Affiliation(s)
- Andrean L Simons
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | | | | | | |
Collapse
|
50
|
The effect of acquisition time on visual and semi-quantitative analysis of F-18 FDG-PET studies in patients with head and neck cancer. Nucl Med Commun 2010; 31:227-31. [DOI: 10.1097/mnm.0b013e328334fbfd] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|