FDG‐PET in the Clinically Negative Neck in Oral Squamous Cell Carcinoma

Wensing, Bart M; Vogel, Wouter V.; Marres, H.A.M.; Merkx, Matthias A.W.; Postema, Ernst J.; Oyen, Wim J.G.; Hoogen, F.J.A. van den

doi:10.1097/01.mlg.0000209151.78362.d0

Cited by 45 publications

(30 citation statements)

References 19 publications

(51 reference statements)

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“…For marginally enlarged lymph nodes, examination by ultrasound imaging (US) with fine-needle aspiration cytology is superior to CT and MRI if performed by an experienced radiologist (sensitivity and specificity up to 76% and 100%, respectively (4,5)). More recently, several studies have been performed to assess the value of 18 F-FDG PET for cervical lymph node staging (6)(7)(8)(9)(10)(11). The results of these studies indicate that the performance of 18 F-FDG PET is not clearly superior to US, CT, or MRI.…”

mentioning

confidence: 85%

18F-FLT PET Does Not Discriminate Between Reactive and Metastatic Lymph Nodes in Primary Head and Neck Cancer Patients

Troost¹,

Vogel²,

Merkx³

et al. 2007

Journal of Nuclear Medicine

146

118

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Repopulation of clonogenic tumor cells is inversely correlated with radiation treatment outcome in head and neck squamous cell carcinomas. A functional imaging tool to assess the proliferative activity of tumors could improve patient selection for treatment modifications and could be used for evaluation of early treatment response. The PET tracer 39-deoxy-39-18 F-fluorothymidine ( 18 F-FLT) can image tumor cell proliferation before and during radiotherapy, and it may provide biologic tumor information useful in radiotherapy planning. In the present study, the value of 18 F-FLT PET in determining the lymph node status in squamous cell carcinoma of the head and neck was assessed, with pathology as the gold standard. Methods: Ten patients with newly diagnosed stage II-IV squamous cell carcinoma of the head and neck underwent 18 F-FLT PET before surgical tumor resection with lymph node dissection. Emission 18 F-FLT PET and CT images of the head and neck were recorded and fused, and standardized uptake values (SUVs) were calculated. From all 18 18 F-FLT PET-positive lymph node levels and from 8 18 F-FLT PET-negative controls, paraffin-embedded lymph node sections were stained and analyzed for the endogenous proliferation marker Ki-67 and for the preoperatively administered proliferation marker iododeoxyuridine. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for 18 F-FLT PET. Results: Primary tumor sites were oral cavity (n 5 7), larynx (n 5 2), and maxillary sinus (n 5 1). Nine of the 10 patients examined had 18 F-FLT PET-positive lymph nodes (SUV mean : median, 1.2; range, 0.8-2.9), but only 3 of these patients had histologically proven metastases. All metastatic lymph nodes showed Ki-67 and iododeoxyuridine staining in tumor cells. In the remaining 7 patients, there was abundant Ki-67 and iododeoxyuridine staining of B-lymphocytes in germinal centers in PET-positive lymph nodes, explaining the high rate of false-positive findings. The sensitivity, specificity, positive predictive value, and negative predictive value of 18 F-FLT PET were 100%, 16.7%, 37.5%, and 100%, respectively. Conclusion: In head and neck cancer patients, 18 F-FLT PET showed uptake in metastatic as well as in nonmetastatic reactive lymph nodes, the latter due to reactive B-lymphocyte proliferation. Because of the low specificity, 18 F-FLT PET is not suitable for assessment of pretreatment lymph node status. This observation may also negatively influence the utility of 18 F-FLT PET for early treatment response evaluation of small metastatic nodes.

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mentioning

confidence: 85%

18F-FLT PET Does Not Discriminate Between Reactive and Metastatic Lymph Nodes in Primary Head and Neck Cancer Patients

Troost¹,

Vogel²,

Merkx³

et al. 2007

Journal of Nuclear Medicine

146

118

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“…[14][15][16][17][18][19][20][21][22] These studies show different sensitivities for the detection of occult cervical metastases by FDG PET ranging from 0% to 100% (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

“…23 In this study as well as in three other studies, [14][15][16] the N0 neck was determined by physical examination (palpation) only. In the other five studies the clinically negative neck was defined by both physical examination and radiological investigation [17][18][19][20][21] The two different definitions of a N0-neck used by these studies resulted in high and low sensitivities respectively, with the exception of the FDG PET/ CT study. 17 In the current study the sensitivity would have dropped from 50% to 33% if the results of CT scanning had been used in the definition of a clinically N0-neck.…”

Section: Discussionmentioning

confidence: 99%

FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases

et al. 2008

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FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases Krabbe, Christiaan A.; Dijkstra, Pieter U. ; Pruim, Jan; van der Laan, Bernard F.A.M.; van der Wal, Jacqueline E.; Gravendeel, Joost P.; Roodenburg, Johannes Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Summary Treatment of the clinical N0 neck in squamous cell carcinoma (SCC) of oral cavity and oropharynx remains a dilemma. None of the current imaging modalities are able to detect the presence of micrometastases in the lymph nodes of clinical N0 necks reliably. The aim of this study was to determine the diagnostic properties of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients clinically staged as N0. FDG PET results of 38 patients were compared to histologic specimens obtained with neck dissections or to follow-up. FDG PET performance was compared to computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography-guided fine needle aspiration cytology (USgFNAC). Sensitivity and specificity of FDG PET in detecting occult cervical metastases were 50% and 97% respectively. Although FDG PET performed better than conventional imaging modalities, sensitivity was lower than desired. As a consequence, clinical application of FDG PET in the patient staged as N0 is limited.

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“…Due to cervical lymph node metastasis, there is significantly reduction in the survival of the patient and which is an important prognostic factor for scientific debate today. Positron emission tomography (PET) with fluorodeoxyglucose (FDG) is increasingly day by day as a useful tool in preoperative staging of cancer patients (Bart et al, 2006). According to recent studies and research, FDG-PET scanning shows good accuracy and predictive value in determining lymph node status and thus helping in screening and early diagnosis of oral cancer in affected patients.…”

Section: Pet Scanmentioning

confidence: 99%

Advanced Diagnostic Aids in Oral Cancer

Masthan¹,

Babu²,

Dash³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Oral cancers are one of the most common cancers worldwide today. They are usually neglected by the common population when compared to systemic cancers such as the lung cancer, colon cancer etc. However, they also may be extremely fatal if left untreated even at a very initial stage of the lesion. Early detection and treatment gives the best chance for its cure. The five-year survival rate of oral cancer still remains low and delayed diagnosis is suggested to be one of the major reasons. The detection and diagnosis are currently based on clinical examination, histopathological evaluation of the biopsy material and molecular methods. Several diagnostic aids have been developed over the years for early detection of oral cancer. The purpose of this article is to review the advanced available diagnostic adjuncts for the detection of oral cancer.

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FDG‐PET in the Clinically Negative Neck in Oral Squamous Cell Carcinoma

Abstract: In patients with cN0 SCC of the oral cavity, FDG-PET does not contribute to the preoperative workup. FDG-PET does not replace SOHND as a staging procedure.

Cited by 45 publications

References 19 publications

18F-FLT PET Does Not Discriminate Between Reactive and Metastatic Lymph Nodes in Primary Head and Neck Cancer Patients

18F-FLT PET Does Not Discriminate Between Reactive and Metastatic Lymph Nodes in Primary Head and Neck Cancer Patients

FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases

Advanced Diagnostic Aids in Oral Cancer

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