Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings

Plaxton, Nicholas; Brandon, David; Corey, Amanda S.; Harrison, Chester E.; Kendi, Ayşe Tuba Karagülle; Halkar, Raghuveer; Barron, Bruce J.

doi:10.2214/ajr.14.12828

Cited by 48 publications

(38 citation statements)

References 48 publications

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“…The failure to detect the false-negative primary reflected the limited sensitivity of 18 FDG PET/CT, which is an inherent limitation. 27,28 Our study showed excellent sensitivity, specificity and accuracy of biomarker examinations in MCNs. We used the results of panendoscopy-guided biopsy under general anesthesia as the reference standard to compare those of nodal HPV, p16 and EBV status with 18 F-FDG PET/CT.…”

Section: Tumor Markers and Signaturessupporting

confidence: 52%

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¹⁸F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

et al. 2017

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Squamous cell carcinoma of unknown primary of the head and neck (SCCUP) is a heterogeneous disease entity that requires careful examination to locate the occult primary. We examined the diagnostic value of expression of biomarkers, such as human papillomavirus (HPV), p16 and Epstein-Barr virus (EBV), in metastatic lymph nodes vs. F-fluorodeoxyglucose ( F-FDG) positron emission tomography/computed tomography (PET/CT). We prospectively enrolled 54 consecutive SCCUP patients who received HPV, p16 and EBV analyses of lymph node fine-needle aspirates and F-FDG PET/CT scans and subsequently underwent examinations and biopsies under general anesthesia to detect primary tumors. The diagnostic performance of the biomarkers and F-FDG PET/CT were compared by using receiver operating characteristics (ROC) curve analyses with histopathological results for identification of primary tumors. Primary tumors were identified in 28 (51.9%) of 54 patients: the palatine tonsil in 24, base of the tongue in 1, nasopharynx in 2, and hypopharynx in 1. The sensitivity of p16 (85.7%) and accuracy of HPV (85.2%) were higher than those (42.9% and 68.5%) of F-FDG PET/CT (p< 0.05). The area under the ROC curve of HPV was higher than that of F-FDG PET/CT (0.857 vs. 0.666, p = 0.007). The disease-free survival rates were higher in the patients with primary tumor detection or p16 nodal immunopositivity than in the other patients (p< 0.05). The results showed that HPV and p16 detection in metastatic lymph nodes can help locate hidden primary tumors, guide definitive treatment and predict patient survival.

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Section: Tumor Markers and Signaturessupporting

confidence: 52%

“…In our study, a tumor size <1.5 cm was found in 14 (50%) of 28 occult primaries, of which only 3 (21.4%) were identified by 18 F‐FDG PET/CT scans. The failure to detect the false‐negative primary reflected the limited sensitivity of 18 FDG PET/CT, which is an inherent limitation …”

Section: Discussionmentioning

confidence: 99%

¹⁸F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

et al. 2017

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“…Head-neck tumors often go along with local inflammation. Unfortunately, a recent review reported that most original work found that 18 F-FDG PET/CT is not useful in discriminating benign from malignant tumors because of the overlap of uptake in both conditions (18)(19)(20). In this setting, 68 Ga-FAPI PET/CT may offer an advantage regarding tumor delineation-for example, in planning of radiotherapy ( Fig.…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer

et al. 2019

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The recent development of quinoline-based PET tracers that act as fibroblast-activation-protein inhibitors (FAPIs) demonstrated promising preclinical and clinical results. FAP is overexpressed by cancer-associated fibroblasts of several tumor entities. Here, we quantify the tumor uptake on 68 Ga-FAPI PET/CT of various primary and metastatic tumors to identify the most promising indications for future application. Methods: 68 Ga-FAPI PET/CT scans were requested by various referring physicians according to individual clinical indications that were considered insufficiently covered by 18 F-FDG PET/CT or other imaging modalities. All PET/CT was performed 1 h after injection of 122-312 MBq of 68 Ga-FAPI-04. We retrospectively identified 80 patients with histopathologically proven primary tumors or metastases or radiologically unequivocal metastatic lesions of histologically proven primary tumors. Tumor uptake was quantified by SUV max and SUV mean (60% isocontour). Results: Eighty patients with 28 different tumor entities (54 primary tumors and 229 metastases) were evaluated. The highest average SUV max (.12) was found in sarcoma, esophageal, breast, cholangiocarcinoma, and lung cancer. The lowest 68 Ga-FAPI uptake (average SUV max , 6) was observed in pheochromocytoma, renal cell, differentiated thyroid, adenoid cystic, and gastric cancer. The average SUV max of hepatocellular, colorectal, head-neck, ovarian, pancreatic, and prostate cancer was intermediate . SUV varied across and within all tumor entities. Because of low background in muscle and blood pool (SUV max , 2), the tumor-to-background contrast ratios were more than 3-fold in the intermediate and more than 6fold in the high-intensity uptake group. Conclusion: Several highly prevalent cancers presented with remarkably high uptake and image contrast on 68 Ga-FAPI PET/CT. The high and rather selective tumor uptake may open up new applications for noninvasive tumor characterization, staging examinations, or radioligand therapy. ://jnm.snmjournals.org/content/60/6/801 This article and updated information are available at: http://jnm.snmjournals.org/site/subscriptions/online.xhtml Information about subscriptions to JNM can be found at: http://jnm.snmjournals.org/site/misc/permission.xhtml

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“…[ 18 F]FDG‐PET/CT is useful for the detection of nodal disease and identifies distant metastases or a synchronous primary in up to 15% of head and neck SCC (HNSCC) cases. The quantitative degree of metabolism also has been shown to correlate with disease‐free survival …”

Section: Discussionmentioning

confidence: 99%

Incidental detection of oropharyngeal cancer with fluciclovine PET

et al. 2019

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Background Fluorine‐18‐labeled 1‐amino‐3‐fluorocyclobutane‐1‐carboxylic acid (fluciclovine) is a synthetic amino acid radiopharmaceutical initially developed to improve noninvasive diagnosis of gliomas and currently FDA approved for prostate cancer imaging. Although fluciclovine positron emission tomography (PET) has proven to be efficacious in detecting multiple types of cancer, its ability to detect oropharyngeal squamous cell carcinoma (OPSCC) is largely unknown. Methods We describe a case of incidental OPSCC detection with fluciclovine PET in a 66‐year old male patient during workup for recurrent prostate adenocarcinoma. Results Fluciclovine PET detected a left base of tongue (BOT) lesion, which was subsequently confirmed as invasive SCC on surgical pathology. Conclusion Given these findings, we discuss potential future directions for research with fluciclovine to overcome some of the known limitations of 18[F]fluorodeoxyglucose in oncological imaging.

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Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings

Abstract: Understanding the characteristics of squamous cell carcinoma of the head and neck, as imaged by FDG PET/CT, is crucial for determining treatment strategy, because it helps to avoid incorrect staging and also provides an accurate assessment of treatment response.

Cited by 48 publications

References 48 publications

¹⁸F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

¹⁸F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

⁶⁸Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer

Incidental detection of oropharyngeal cancer with fluciclovine PET

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Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings

Abstract: Understanding the characteristics of squamous cell carcinoma of the head and neck, as imaged by FDG PET/CT, is crucial for determining treatment strategy, because it helps to avoid incorrect staging and also provides an accurate assessment of treatment response.

Cited by 48 publications

References 48 publications

18F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

18F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

68Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer

Incidental detection of oropharyngeal cancer with fluciclovine PET

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Product

Resources

About

¹⁸F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

¹⁸F-FDG PET/CTvs. human papillomavirus, p16 and Epstein-Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

⁶⁸Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer