Assessment of a New 18F-FDG PET/CT Protocol in the Staging of Oral Cavity Carcinomas

Abstract

Because image fusion using 18 F-FDG PET/CT allows a better localization of the pathologic uptake, this modality has a greater sensitivity than PET alone in examining the head-neck region. However, examination of this area is particularly critical because the head and neck are close to other anatomic structures and because of the high physiologic uptake of the radiocompound. The purpose of this study was to evaluate the utility of a new imaging protocol in the staging of oral carcinoma. Methods: Thirty-four consecutive patients (21 women and 13 men; age range, 20-84 y) with untreated biopsy-proven oral squamous cell carcinomas were examined using whole-body 18 F-FDG PET/CT fusion imaging. All patients observed strict regulations before undergoing the PET/CT examination. At the end of the whole-body acquisition, another open-mouth scan was obtained. To compare the open-and closed-mouth methods, we analyzed features such as the feasibility of an accurate topographic localization of the tumor, evaluation of tumor extent, detection of tumor involvement with adjacent structures, and involvement of lymph nodes to which we assigned a score from 1 to 5. Results: No cases of 18 F-FDG physiologic uptake in the tongue or muscles were observed. The open-mouth scan obtained a better score than did the closed-mouth scan when considering the tumor localization, tumor extent, and evaluation of adjacent anatomic structures near the clinically evident tumor. For lymph node involvement, the 2 methods showed similar results. Conclusion:The open-mouth scan improved the anatomic tumor localization and extent and detection of tumor involvement in adjacent anatomic structures achieved by the standard PET/CT procedure. In addition, time of the examination (mid morning), relaxation of muscles before the compound was administered, and an upright position while the patient waited caused a reduction of the frequent equivocal physiologic uptake in the head and neck region. The open-mouth method does not influence the nodal staging.

Contribution of Open Mouth Technique in ¹⁸F-FDG PET/CT Imaging in Patients with Malignant Lip Neoplasm

“…Cistaro et al ( 18 ) evaluated usefulness of the OM technique in patients with oral cavity carcinomas. They found that for anatomic localization and detection of tumor extent, OM images always resulted in better visualization than conventional CM images.…”

“…They included 34 patients with oral cavity tumors in their studies, and only one of them had lip cancer. Our study is the first and only to compare two techniques in patients with lip cancer homogeneously ( 18 ).…”

Oral cavity tumors in children. Diagnostic approach

“…Mid-morning scheduling of the examination, relaxation of muscles before the radiotracer administration, and a wait time with the patient upright may reduce the equivocal physiologic uptake generally frequent in this area. Finally, this imaging protocol seems to allow a better localization of potentially synchronous tumors [13].…”

Distinct Imaging Modalities in Head and Neck Cancer: Benefits and Drawbacks

“…The primary aim of the preliminary imaging of a patient with a HNSCC is to decide the clinical stage with the prominent attainable accuracy. In this concern, head-totoe 18F-FDG PET/CT (Fluorodeoxyglucose) permits the TNM stage to be discovered noninvasively in an individual process (Chang et al, 2013;Cistaro et al, 2011) Certain article have publicised excessive sensitivity and speci icity of 18F-FDG PET in association to conservative radiological standards along with the histological gold standard. (Differding et al, 2015) PET/CT PET/CT is higher to CT and MRI in inding of carcinoma of cervical lymph node metastasis, distant metastasis, remaining tumour, persevering sickness and second essential tumors causing in change in the therapy Table 2 However, the examination of FDG PET/CT investigation in the head and neck is fascinating as of the typically compound life systems, physiologic varieties, and strange design of FDG take-up following radiation treatment and medical procedure (Beltagi et al, 2019) Since FDG isn't a tumour-exact pointer, it can assemble in a range of benign progressions with benign tumours, in lammatory, post traumatic disorders.…”

“…On hurling the cheeks, the oral vestibule is squeezed with air, by making a negative contrast partitions of buccal and labial mucosa from the gingival mucosa, permitting both mucosal surfaces to be evaluated independently (Cistaro et al, 2011;Chang et al, 2013)…”