Is there a role for positron emission tomography with 18F‐fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma

Stoeckli, Sandro J.; Steinert, H.; Pfaltz, Madeleine; Schmid, Stephan

doi:10.1002/hed.10057

Cited by 172 publications

(77 citation statements)

References 19 publications

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“…It is still a matter of controversy as to how FDG-PET/CT should be integrated into the staging algorithm of patients with HNSCC [24]. We use FDG-PET/CT in patients with suspected advanced primaries and/or metastases, and we recommend that it should be performed prior to panendoscopy.…”

Section: Discussionmentioning

confidence: 99%

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

Strobel

Haerle

Stoeckli

et al. 2009

Eur J Nucl Med Mol Imaging

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117

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Purpose The aim of the study was to evaluate 18 F-FDG-PET/CT for the detection of synchronous primaries at initial staging of patients with head and neck squamous cell carcinoma (HNSCC). Methods FDG-PET/CT images acquired between March 2001 and October 2007 in 589 consecutive patients (147 women, 442 men; mean age 61.5 years, age range 32-97 years) with proven HNSCC were reviewed for the presence of synchronous primaries. Cytology, histology and/or clinical and imaging follow-up served as reference standard.Results FDG-PET/CT showed 69 suspected synchronous primaries in 62 patients of which 56 were finally confirmed in 44 patients. Of the 56 second cancers, 46 (82%) were found in the aerodigestive tract in the following locations: lung (26, 46%), head and neck (15, 17%), oesophagus (5, 9%). Ten second cancers (18%) were located outside the aerodigestive tract (colon, five; stomach, lymphoma, breast, thymus and kidney, one each). Six patients had three synchronous primaries and three patients had four synchronous cancers. Nine synchronous cancers were not detected by PET/CT (four head and neck, two lung, two oesophageal, one gastric). False-positive PET/CT findings were mainly related to benign FDG uptake in the intestine due to benign or precancerous polyps or physiological FDG uptake in other head and neck regions. Overall the prevalence of synchronous second primaries according to the reference standard was 9.5%, of which 84% were detected with FDG-PET/CT. In 80% of the patients, therapy was changed because of the detection of a synchronous primary. Conclusion FDG-PET/CT detects a considerable number of synchronous primaries (8.0% prevalence) at initial staging of patients with HNSCC. Synchronous cancers were predominantly located in the aerodigestive tract, primarily in the lung, head and neck and oesophagus. Detection of second primaries has an important impact on therapy. PET/ CT should be performed before panendoscopy.

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Section: Discussionmentioning

confidence: 99%

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

Strobel

Haerle

Stoeckli

et al. 2009

Eur J Nucl Med Mol Imaging

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117

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“…The results of this study reinforce what was reported by Schoder et al in the clinically lymph nodal-negative neck (25). Despite a reasonably high overall accuracy, the clinical application of 18 F-FDG PET/CT may be limited by the suboptimal sensitivity for small metastases and the relatively high number of false-positive findings (28).…”

Section: Discussionmentioning

confidence: 99%

Assessment of a New 18F-FDG PET/CT Protocol in the Staging of Oral Cavity Carcinomas

Cistaro¹,

Palandri²,

Balsamo³

et al. 2011

Journal of Nuclear Medicine Technology

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Because image fusion using 18 F-FDG PET/CT allows a better localization of the pathologic uptake, this modality has a greater sensitivity than PET alone in examining the head-neck region. However, examination of this area is particularly critical because the head and neck are close to other anatomic structures and because of the high physiologic uptake of the radiocompound. The purpose of this study was to evaluate the utility of a new imaging protocol in the staging of oral carcinoma. Methods: Thirty-four consecutive patients (21 women and 13 men; age range, 20-84 y) with untreated biopsy-proven oral squamous cell carcinomas were examined using whole-body 18 F-FDG PET/CT fusion imaging. All patients observed strict regulations before undergoing the PET/CT examination. At the end of the whole-body acquisition, another open-mouth scan was obtained. To compare the open-and closed-mouth methods, we analyzed features such as the feasibility of an accurate topographic localization of the tumor, evaluation of tumor extent, detection of tumor involvement with adjacent structures, and involvement of lymph nodes to which we assigned a score from 1 to 5. Results: No cases of 18 F-FDG physiologic uptake in the tongue or muscles were observed. The open-mouth scan obtained a better score than did the closed-mouth scan when considering the tumor localization, tumor extent, and evaluation of adjacent anatomic structures near the clinically evident tumor. For lymph node involvement, the 2 methods showed similar results. Conclusion:The open-mouth scan improved the anatomic tumor localization and extent and detection of tumor involvement in adjacent anatomic structures achieved by the standard PET/CT procedure. In addition, time of the examination (mid morning), relaxation of muscles before the compound was administered, and an upright position while the patient waited caused a reduction of the frequent equivocal physiologic uptake in the head and neck region. The open-mouth method does not influence the nodal staging.

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“…Studies applying a radiolabelled tracer with or without additional blue dye, however, were promising. The majority of the studies reported results favouring the sentinel lymph-node concept (Koch et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Zitsch et al, 2000;Mozzillo et al, 2001;Stoeckli et al, 2001Stoeckli et al, , 2002Barzan et al, 2002;Werner et al, 2002a, b). Groups who worked with blue dye report of an extravasation of the blue dye into the tissue (Pitman et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph-node biopsy in head and neck cancer

et al. 2004

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The aim of the study was to assess the diagnostic value of the sentinel node method in patients suffering from squamous cell carcinoma of the upper aerodigestive tract. In 50 patients with oral, pharyngeal or laryngeal carcinomas staged N0 up to 50 MBq technetium-99m colloid were injected peritumorally. Sentinel nodes were localised using a g-probe in the setting of an elective neck dissection. Pathological findings of sentinel nodes and corresponding neck specimens were compared. In 46 patients sentinel nodes were detected. Of these 34 patients were free of metastatic disease in the sentinel nodes and in the neck specimens. In 12 patients clinically occult metastases were found in the sentinel nodes. Three metastases were detected only after additional sectioning of the sentinel nodes. In four patients, a sentinel lymph node could not be localised. Our results support the sentinel node concept in head and neck cancer and a definition of the sentinel nodes as the three nodes with the highest activity. Careful clinical staging of the neck and thorough pathological evaluation of the sentinel nodes are necessary to avoid false-negative results.

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Is there a role for positron emission tomography with 18F‐fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma

Cited by 172 publications

References 19 publications

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

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

Assessment of a New 18F-FDG PET/CT Protocol in the Staging of Oral Cavity Carcinomas

Sentinel lymph-node biopsy in head and neck cancer

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