Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis

Abstract

The overall diagnostic performance of post-treatment FDG PET(CT) for response assessment and surveillance imaging of HNSCC is good, but its PPV is somewhat suboptimal. Its NPV remains exceptionally high and a negative post-treatment scan is highly suggestive of absence of viable disease that can guide therapeutic decision-making. Timing of post-treatment imaging has a significant, though moderate impact on diagnostic accuracy.

Addition of 18F-FDG PET/CT to Clinical Assessment Predicts Overall Survival in HNSCC: A Retrospective Analysis with Follow-up for 12 Years

“…About 50%-70% of patients with head and neck squamous cell carcinoma (HNSCC) achieve a complete response, with residual or recurrent disease being detected in 30%-50% of cases either at the primary site or in the neck (6). Approximately 80% of tumor recurrence in HNSCC occurs during the first 2 y after treatment (7).…”

Diagnostic Performance of Diffusion-Weighted MRI and FDG PET/CT for Detecting the Local Recurrence of Head and Neck Squamous Cell Carcinoma

“…Edema, active inflammatory reactions, and increased vascular permeability are the major changes after radiation therapy, especially during the first 6 months (14). Therefore, the optimum timing for post-treatment imaging is 12 weeks or more after the completion of radiotherapy (12). In this study, the time of post-treatment imaging was as early as 43 days (range: 43-103 days) in some patients.…”

“…In a recent review of diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancers, Gupta et al (12) reported that the pooled sensitivity and specificity for detecting residual disease at the primary site was 79.9% (95% CI: 73.7%-85.2%) and 87.5% (95% CI: 85.2%-89.5%), respectively; the review included a total of 24 studies involving 1122 patients. The optimal cutoff value of SUV max was found to be 7.6 in our study.…”

Condroradionecrose de laringe após radioterapia

“…Since recurrences are much more frequent than chondroradionecrosis, deep biopsies should be performed for restaging, although they may worsen the infection and local necrosis (14,37). Currently, this diagnostic dilemma can be resolved through PET-CT, in which tumor activity is evident in the larynx if relapse occurs, but examination should be done only three months after the end of radiotherapy to eliminate the interference of actinic inflammation [42][43][44] . All our three chondroradionecrosis patients underwent PET-CT, with a negative result for tumor recurrence, a fact evidenced by the performed biopsies.…”

“…The authors demonstrated a sensitivity of 89% and specificity of 74% of the PET-CT to differentiate between tumor recurrence and local actinic late alterations. It should therefore be the exam of choice to avoid unnecessary CT scans and laryngoscopies with biopsies 42,43,45 . The various treatments proposed for chondroradionecrosis included the use of antibiotic therapy, air humidifiers, corticosteroids, antireflux drugs (proton pump blockers, prokinetics) and hyperbaric chamber (HBC), the latter being in varied regimens.…”