Advantages and pitfalls of 18F-fluoro-2-deoxy-D-glucose positron emission tomography in detecting locally residual or recurrent nasopharyngeal carcinoma: comparison with magnetic resonance imaging

Abstract

(18)F-FDG PET is superior to MRI in identifying locally residual NPC among patients with initial T4 disease but demonstrates limitations in assessing treatment response in patients with initial T1-2 disease after ICBT. A cut-off SUV is a useful index for aiding in the visual detection of locally residual/recurrent NPC.

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

“…21 Post-treatment surveillance for the detection of residual/recurrent tumors or distant disease is a diagnostic challenge, because tissue distortion and inflammatory reaction from surgery and radiotherapy can obscure the early detection of recurrence by conventional workups, such as physical examination, endoscopy, CT, and MRI. For the detection of residual/recurrent NPC, 18 F-FDG PET reportedly was superior to MRI only for patients who initially had T4 disease, 10 and the combined use of MRI and PET/CT was more accurate for tumor restaging than when either modality was used independently. 11 With regard to the detection of metastatic/recurrent NPC, 18 F-FDG PET reported was a sensitive diagnostic tool, with sensitivity between 89.5% and 92%, specificity between 55.6% and 90%, and accuracy between 72.9% and 91%.…”

“…One of the strengths of our results is that our patients have been followed for a median of 60 months, and 87.8% have had at least 1 lesion verified on biopsy/resection; these figures are much higher than those reported by others. [10][11][12][13] Because both EBV DNA assays and PET scans have improved diagnostic yields in detecting post-treatment failures in patients with NPC, several difficult situations arise. For example, patients who have abnormal PET findings but undetectable EBV DNA levels or who have elevated EBV DNA levels but no evidence of recurrence/ metastasis on PET or other clinical/imaging studies present a dilemma in terms of determining whether or not to treat.…”

“…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. [14][15][16][17][18][19][20] However, the combined use of both new modalities for detecting recurrent NPC is not yet well defined.…”

Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma

“…6,7,13,14 Moreover, to our knowledge, only one study has investigated the prognostic value of the post-radiotherapy 18 F-FDG PET response for predicting survival outcomes. 13 Therefore, in the present study, we evaluated (1) the clinical significance of the post-radiotherapy 18 F-FDG PET response for detecting residual disease at primary tumors as well as at regional lymph nodes (LNs) and for predicting survival outcomes in patients with nasopharyngeal cancer, and (2) the clinical significance of the post-radiotherapy 18 F-FDG PET response depending on the timing of post-radiotherapy 18 F-FDG PET.…”

Value of 18F-FDG heterogeneity for discerning metastatic from benign lymph nodes in nasopharyngeal carcinoma patients with suspected recurrence

“…7 However, there remain limitations in identifying recurrence by 18 F-FDG uptake alone. 8,9 Novel parameters of FDG PET may therefore improve the diagnostic accuracy for detecting NPC recurrence.…”