18F-FDG PET Can Replace Conventional Work-up in Primary M Staging of Nonkeratinizing Nasopharyngeal Carcinoma

Abstract

Conventional work-up (CWU) with chest radiography, abdominal ultrasonography, and skeletal scintigraphy has limited value in M staging of nonkeratinizing nasopharyngeal carcinoma (NPC). Our aim was to evaluate whether 18 F-FDG PET could replace CWU by comparing their diagnostic efficacies. Methods: Patients with histologically proven nonkeratinizing NPC and no prior treatment were prospectively enrolled. All study participants underwent CWU and 18 F-FDG PET for primary M staging. Distant metastasis was considered to be present if there was any reliable evidence identified within 1 y after diagnosis. The comparative diagnostic efficacies of 18 F-FDG PET, CWU, and the combination of 18 F-FDG PET and CWU (PET1CWU) were evaluated using the areas under the receiver-operating-characteristic (ROC) curves. Results: Sixty-one (20.3%) of 300 eligible patients were found to have distant metastases. On a patient-based analysis, 18 F-FDG PET was found to be more effective than CWU (P , 0.001), whereas it was equally effective with PET1CWU (P 5 0.130). On region-based analyses, 18 F-FDG PET was more effective than skeletal scintigraphy and chest radiography for detecting bone metastases (P , 0.001) and chest metastases (P , 0.001), respectively. 18 F-FDG PET and abdominal ultrasound were equally effective for detecting hepatic metastases (P 5 0.127). On region-based analyses, the combination of 18 F-FDG PET and CWU did not yield any noticeable increase in diagnostic efficacy. Conclusion: 18 F-FDG PET can replace CWU in primary M staging of nonkeratinizing NPC.

Meta-analysis of diagnostic value of 18F-FDG PET or PET/CT for detecting lymph node and distant metastases in patients with nasopharyngeal carcinoma

“…The histopathological results could be obtained by biopsy or surgical excision. 10,26 In addition, some information about scanning technique is also presented in Table 1. Only four studies used PET, while all the rest used PET/CT.…”

“…No study reported that the reference standard was masked to the index test result (Item 11), and the index test was masked to the reference standard (Item 10) in 12 studies. 10,14,15,19,22,[24][25][26][27][30][31][32] The reporting of uninterpretable results (Item 13) and explanation of withdrawals from the study (Item 14) were presented in 12 studies 10,12,14,15,[19][20][21]25,28,[30][31][32] and 4 studies 10,14,26,27 , respectively.…”

“…There were 7 studies for N staging and 13 studies for M staging. Eight articles 10,14,15,23,[25][26][27]32 certainly enrolled patients prospectively, and the other study designs were retrospective. Obviously, most studies were performed in Asia, especially in China.…”

“…After reviewing the title and abstract, we excluded 556 obviously irrelevant articles. For the remaining 99 articles, we read full texts, and 18 articles 10,12,14,15,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] consisting 20 studies fulfilled all inclusion criteria and were included for data analysis.…”

Plasma Epstein‐Barr virus DNA screening followed by 18F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography in detecting posttreatment failures of nasopharyngeal carcinoma

“…Conventional workups, including physical examinations, endoscopy, computerized tomography (CT) scans, magnetic resonance imaging (MRI), chest radiography, whole-body bone scans, and abdominal sonography, have limited sensitivity and specificity in the early diagnosis of recurrent NPC. Recently, functional imaging with 18 F-fluoro-2-deoxy-D-glucose ( 18 F-FDG) positron emission tomography (PET) scans or PET/CT scans has demonstrated encouraging efficacy in NPC staging, [1][2][3][4][5][6] response evaluation, [7][8][9] and relapse detection. [10][11][12][13] Another important advance in NPC is the quantification of plasma EBV DNA with real-time quantitative polymerase chain reaction (rt-qPCR), which reportedly is a useful tool for the detection, monitoring, and prognostic prediction in NPC.…”