Positron Emission Tomography With [¹⁸F]Fluorodeoxyglucose Improves Staging and Patient Management in Patients With Head and Neck Squamous Cell Carcinoma: A Multicenter Prospective Study

Abstract

PURPOSE To address the impact of positron emission tomography with [(18)F]fluorodeoxyglucose (PET-FDG) on the initial staging and management of patients with head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS This multicenter, prospective study included 233 patients with newly diagnosed and untreated HNSCC. TNM stage and therapeutic decision were first determined based on the conventional work-up (including physical examination, computed tomography [CT]/magnetic resonance imaging of the head and neck region, and thoracic CT) and sealed in envelope 1. Whole-body PET-FDG was then performed, and subsequent TNM stage and therapeutic decision were written in envelope 2. Changes in TNM stages and in patient management as a result of PET-FDG imaging were recorded. Clinical outcome and histopathology were used as gold standards to validate the TNM stage. Conventional and PET stages were compared using the McNemar test. Results Conventional and PET stage were discordant in 100 (43%) of 233 patients. PET proved to be accurate in 47 patients and inaccurate in 13 patients. TNM status was left unconfirmed in 40 patients because no therapeutic change was expected from the stage difference. Conventional + PET TNM classification (envelope 2) was significantly more accurate than conventional classification (envelope 1; P < .0001, McNemar test). PET-FDG altered the therapeutic plan in 32 (13.7%) of 233 patients. CONCLUSION Adding whole-body PET-FDG to the pretherapeutic conventional staging of HNSCC improved the TNM classification of the disease and altered the management of 13.7% of patients. These findings support the implementation of PET-FDG in the routine imaging work-up of HNSCC.

PET‐CT Staging of the Neck in Cancers of the Oropharynx: Patterns of Regional and Retropharyngeal Nodal Metastasis

“…PET-CT findings in this study are in agreement with this data confirming that PET-CT could accurately detect nodal disease in the staging of head and neck cancer patients. Furthermore, several studies have already shown that adding PET-FDG or PET/CT-FDG to standard work-up led to a higher staging accuracy with higher specificity [18][19][20][21].…”

Valor da PET/CT na abordagem do câncer de cabeça e pescoço

“…Lonneux et al (10) have developed a prospective study aimed at evaluating the use of PET/CT in the initial staging of head and neck cancer and its impact on the therapeutic decision making. The authors have found disagreement in relation to initial staging in 43% of the cases.…”

“…In head and neck oncology, the main clinical situations comprise the initial staging and investigation of lymph node metastatic disease (7,8) and hematogenic disease, detection of primary lesions in cases of occult primary tumors (9) , evaluation of response to radiotherapy and/or chemotherapy, and investigation of early recurrence of disease and second primary tumor. In all such conditions changes in the approach may potentially occur (10) . In some series, the second tumor incidence ranged between 11.1% and 12.9% (11,12) , while lymph node disease presented specificity of 87% to 100% and sensitivity between 47% and 100% (13) .…”

Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy

“…For primary tumor diagnosis, 18 F FDG-PET imaging showed a significant better sensitivity (93% vs 65%) and specificity (70% vs 56%) over CT (Gambhir et al, 2001). PET imaging allows a more accurate nodal staging of locally advanced head and neck cancer (Kyzas et al, 2008;Yoo et al, 2013), and could result in changing the therapeutic management in nearly 15% of patients (Lonneux et al, 2010). For patients with cervical node metastases of unknown primary, PET/CT detected a primary tumor in nearly 30% of patients (Rudmik et al, 2011;Wong et al, 2012;Zhu and Wang, 2013).…”