Contribution of 18F-FDG PET/CT to Staging of Head and Neck Malignancies

Abstract

Objective: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.Conclusion:PET/CT in HNC contributes to staging, thus playing a role in treatment planning, especially in patients with locally advanced disease.

Does PET scan have any role in the diagnosis of perineural spread associated with the head and neck tumors?

“…We obtained the pooled OR value of 3.088 with 95% CI of [1.486; 6.419]. Data used for this analysis were heterogeneous, and we achieved the Q value of 33.8%, df value of 13, I 2 value of 61.5% (31.23-78.5), 2011 10 Pereira et al 2012 11 Karapolat and Kumanlıoğlu 2012 12 Gődény et al 2016 13 Ceylan et al 2018 14 Sherif et al 2018 15 Schroeder et al…”

“…However, because of the high sensitivity and specificity of 18 F-FDG PET for cellular change and tumors, its use is highly recommended in various studies due to its high sensitivity in detecting perineural spread and recurrent metastatic tumors. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] For example, Linz et al reported the sensitivity of 18 F-FDG PET as 78.6% and specificity as 83.1%. 19 Similarly, Sherif et al reported a high sensitivity of 83.33% and specificity of 89.47%.…”

“…Demographic summary of the patients and event data of the included studies are summarized in Table 1. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Two authors (XN and JZ) scanned the relevant sources for related studies separately. Mainly, the full-texts articles of the sources were collected, and abstracts were used to obtain sufficient information for the meta-analysis.…”

“…Among these, the use of 18 F-FDG PET (PET with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG)) is highly recommended in various studies due to its high sensitivity for detecting perineural spread and recurrent metastatic tumors. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] For example, Schroeder et al reported that MRI and 18 F-FDG PET have identical detection rates of recurrent metastatic tumors. 16 Similarly, Lee et al reported that the application of 18 F-FDG PET in clinical diagnosis could enhance the tumor detection rate in head and neck cancers.…”

A case series on the conservative management of the bony skull in patients with aggressive skin carcinomas of the scalp

“…[ 5 ] reported an average 3.4 mm underestimation of the extent of SCC invasion into the mandible when using radiological imaging. For head and neck cancer detection, reported sensitivity values for positron emission tomography/computed tomography (CT) scans range from 0.68% [ 6 ], for CT scans—85.7% [ 7 ] and magnetic resonance imaging scans—75.8% [ 8 ].…”