Impact of [¹⁸F]‐2‐Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography on Previously Untreated Head and Neck Cancer Patients

Abstract

The benefit of the PET/CT imaging modality resides in its fusion of anatomic detail of the HN region with the sensitivity of detecting tumors with increased metabolic activity at distant sites. Treatment was altered in 30.9% of our previously untreated HN cancer patients because of this imaging technique, with altered treatment including upstaging, diagnosing distant and unresectable disease, and working-up second primary malignancies. The false-positive findings did not result in additional morbidity to these patients. Although PET/CT is sensitive in detecting occult cervical nodal metastases, it does not yet have the ability to replace neck dissection as the diagnostic standard of care. This study supports the use of PET/CT in patients with newly diagnosed HN cancer because of its high PPV and superiority of detecting distant metastases and synchronous lesions.

Head and neck squamous cell carcinoma (HNSCC) – detection of synchronous primaries with 18F-FDG-PET/CT

“…There are only a few studies concerned with the detection of second primaries with FDG-PET or FDG-PET/CT. Fleming et al described 123 patients with head and neck tumours initially staged with FDG-PET/CT [7]. PET/CT indicated ten suspected synchronous primaries (8.1%).…”

“…At our institution a prevalence of second primary tumours detected with panendoscopy of 16.2% has been found, with 6.4% being synchronous and 9.8% being metachronous [6]. 18 F-Fluoro-deoxy-glucose positron emission tomography (FDG-PET/CT) is increasingly used for staging of HNSCC with a considerable impact on treatment decisions [7][8][9]. In comparison to morphological imaging methods such as CT or MRI, PET/ CT has the great advantage of assessing the primary tumour, the neck nodes and the potential distant metastases and second primaries in a single examination.…”

18F-FDG PET/CT Imaging In Oncology

“…18 F-FDG PET/CT alters the initial clinical staging and TNM category of the tumor in 14% to 57% of the patients when compared with CT-based evaluation alone,4445 and has an accuracy of approximately 90% compared with 86% for conventional CT 4647…”

“…18 F-FDG PET/CT has been found to identify synchronous primaries in 8.1%, distant metastases in 15.4% and the site of an unknown primary in 73% of the patients with head and neck cancer 46. In addition, it alters the initial management in 18% to 37% of the patients 4649.…”

“…In addition, it alters the initial management in 18% to 37% of the patients 4649. The impact of 18 F-FDG PET/CT on radiotherapy planning is especially important: planning is changed in 29% of the patients,50 with an alteration in the gross tumor volume in 57% of the patients 45.…”