Metastatic Head and Neck Cancer: Role and Usefulness of FDG PET in Locating Occult Primary Tumors

AAssar, O. Sami; Fischbein, Nancy J.; Caputo, Gary R.; Kaplan, Michael; Price, David C.; Singer, Mark I.; Dillon, William P.; Hawkins, Randall A.

doi:10.1148/radiology.210.1.r99ja48177

Cited by 157 publications

(77 citation statements)

References 18 publications

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“…Sensitivities of comparable reports range from 15% to 73% (13,(26)(27)(28). None of the imaging modalities in the current series identified the occult primary in the 6 patients who presented with nodal metastasis but no known primary tumor.…”

Section: Discussionmentioning

confidence: 58%

Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

Rodrigues¹,

Bozza²,

Christian³

et al. 2009

J Nucl Med

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The purpose of this study was to compare optimized whole-body (WB) and dedicated high-resolution contrast-enhanced PET/CT protocols and contrast enhanced CT in the preoperative staging of primary squamous cell carcinoma of the head and neck. Methods: A total of 44 patients with clinically M0 squamous cell carcinoma of the head and neck underwent primary tumor resection and neck dissection within 6 wk of diagnostic imaging. Imaging consisted of a standard WB PET/CT protocol without intravenous contrast enhancement, followed by a high-resolution dedicated head and neck (HN) PET/CT protocol, which included diagnostic-quality contrast-enhanced CT (CECT). Imaging results were compared with histopathology. A 5-point scale was used to designate primary tumor localization and the presence of lymph node metastasis on a per-patient and per-level basis. For cervical nodes, receiver-operating-characteristic curves were generated to determine the differences in performance between the WB and HN PET/CT protocols and CECT. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for primary tumor and cervical nodes. Results: No statistical difference was observed between WB and HN PET/CT protocols, both of which significantly outperformed CECT, in the evaluation of the primary tumor. The performance of the HN PET/CT protocol was superior to that of the WB PET/CT in the detection of cervical node metastases, achieving statistical significance on a per-level basis and approaching significance on a per-patient basis, with the greatest advantage in the detection of small positive lymph nodes (,15 mm). No significant difference was observed between the WB PET/CT protocol and CECT in nodal staging, either on a per-patient or on a per-level basis. Conclusion: The primary advantage of the dedicated HN PET/CT protocol over the WB protocol or CECT in the staging of head and neck cancer is in the detection of small lymph node metastases.

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Section: Discussionmentioning

confidence: 58%

Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

Rodrigues¹,

Bozza²,

Christian³

et al. 2009

J Nucl Med

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“…The evaluation of potentially increased metabolic activity on 18 F-FDG PET has been shown to be highly valuable for detection of tumors (17,18). Yet, adding morphologic information to the metabolic data is considered beneficial for counteracting potential false-negative PET findings based on the low spatial resolution of PET (,10 mm) or 18 F-FDG tumors with little to no avidity (19,20).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Diffusion-Weighted Imaging in Simultaneous ¹⁸F-FDG PET/MR Imaging for Whole-Body Staging of Women with Pelvic Malignancies

et al. 2014

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The aim of this study was to assess the diagnostic benefit of diffusion-weighted imaging (DWI) in an 18 F-FDG PET/MR imaging protocol for whole-body staging of women with primary or recurrent malignancies of the pelvis. Methods: Forty-eight patients with a primary pelvic malignancy or suspected recurrence of a pelvic malignancy were included in our study. All patients underwent a whole-body 18 F-FDG PET/MR imaging examination that included DWI. Two radiologists separately evaluated the PET/MR imaging datasets without DWI followed by a second interpretation with DWI. First, both readers identified all primary tumors, as well as lymph node and distant metastases. In a second session, PET and DWI data were assessed qualitatively. Image interpretation comprised lesion conspicuity defined as visual lesion-to-background contrast (4-point ordinal scale) and diagnostic confidence (3-point ordinal scale) for all tumors. The results from histopathologic examination and cross-sectional imaging follow-up ($6 mo) were used as the reference standard. Statistical analysis was performed to assess the significance of differences between obtained values. Results: Among the 122 suspected lesions seen, 98 (80.3%) were considered malignant. PET/MR imaging without DWI had a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 92.9%, 87.5%, 96.8%, 75.0%, and 91.8%, respectively, for the detection of malignant lesions. PET/MR imaging with DWI had slightly higher values (94.9%, 83.3%, 95.9%, 80.0%, and 92.6%, respectively), but the difference was not significant (P . 0.05). In the qualitative assessment of lesion-to-background contrast, PET had significantly (P , 0.05) higher values (3.79 ± 0.58) than DWI (3.63 ± 0.77). Furthermore, significantly (P , 0.05) higher scores were found for diagnostic confidence using PET (2.68 ± 0.64) for the determination of malignant lesions, when compared with DWI (2.53 ± 0.69). Conclusion: DWI in PET/MR imaging has no diagnostic benefit for whole-body staging of women with pelvic malignancies. The omission of DWI for staging or restaging gynecologic cancer may significantly reduce examination times, thus increasing patient comfort without a relevant decrease in diagnostic competence.

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“…One advantage of PET over other imaging modalities, such as computed tomography (CT) or magnetic resonance imaging (MRI), is that since PET imaging visualizes metabolic processes in vivo, relatively small tumours can be detected before structural changes have taken place, as long as they are metabolically active [79]. In fact, previously unapparent tumours, as small as 3 mm, have been detected by PET imaging [80].…”

Section: Positron Emission Tomography (Pet)mentioning

confidence: 99%

The Outline of Prognosis and New Advances in Diagnosis of Oral Squamous Cell Carcinoma (OSCC): Review of the Literature

Omar

2013

Journal of Oral Oncology

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Objective. Oral squamous cell carcinoma (OSCC) has a remarkable incidence over the world and a fairly strenuous prognosis, encouraging further research on the prognostic factors and new techniques for diagnosis that might modify disease outcome. Data Sources. A web-based search for all types of articles published was initiated using Medline/Pub Med, with the key words such as oral cancer, prognostic factors of oral cancer, diagnostic method of oral cancer, and imaging techniques for diagnosis of oral cancer. The search was restricted to articles published in English, with no publication date restriction (last update April, 2013). Review Methods. In this paper, I approach the factors of prognosis of OSCC and the new advances in diagnostic technologies as well. I also reviewed available studies of the tissue fluorescence spectroscopy and other noninvasive diagnostic aids for OSCC. Results. The outcome is greatly influenced by the stage of the disease (especially TNM). Prognosis also depends or varies with tumour primary site, nodal involvement, tumour thickness, and the status of the surgical margins. Conclusion. Tumour diameter is not the most accurate when compared to tumour thickness or depth of invasion, which can be related directly to prognosis. There is a wide agreement on using ultrasound guided fine needle aspiration biopsies in the evaluation of lymph node metastasis.

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Metastatic Head and Neck Cancer: Role and Usefulness of FDG PET in Locating Occult Primary Tumors

Abstract: FDG PET allows effective localization of the unknown primary site of origin in metastatic head and neck cancer and can contribute substantially to patient care.

Cited by 157 publications

References 18 publications

Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

Diagnostic Value of Diffusion-Weighted Imaging in Simultaneous ¹⁸F-FDG PET/MR Imaging for Whole-Body Staging of Women with Pelvic Malignancies

The Outline of Prognosis and New Advances in Diagnosis of Oral Squamous Cell Carcinoma (OSCC): Review of the Literature

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Metastatic Head and Neck Cancer: Role and Usefulness of FDG PET in Locating Occult Primary Tumors

Abstract: FDG PET allows effective localization of the unknown primary site of origin in metastatic head and neck cancer and can contribute substantially to patient care.

Cited by 157 publications

References 18 publications

Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

Diagnostic Value of Diffusion-Weighted Imaging in Simultaneous 18F-FDG PET/MR Imaging for Whole-Body Staging of Women with Pelvic Malignancies

The Outline of Prognosis and New Advances in Diagnosis of Oral Squamous Cell Carcinoma (OSCC): Review of the Literature

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Diagnostic Value of Diffusion-Weighted Imaging in Simultaneous ¹⁸F-FDG PET/MR Imaging for Whole-Body Staging of Women with Pelvic Malignancies