Preoperative ¹⁸F‐FDG‐PET/CT vs Contrast‐Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma

Abstract

Objective Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design Case series with chart review. Setting Montefiore Medical Center, Bronx, New York. Subjects and Methods Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT ( P = .056, P = .001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT ( P = .014, P = .024). No significant difference was found in overall accuracy ( P = .33, P = .88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.

Accuracy of 18-F Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Imaging in Primary Staging of Squamous Cell Carcinoma of the Oral Cavity

“…The value of positron emission tomography (PET) with 18-F fluorodeoxyglucose (FDG) in the preoperative staging of head and neck SCC has been demonstrated in the literature. [21][22][23][24][25][26] However, only a few prospective studies that used FDG PET/CT imaging in cohorts with SCC of the oral cavity have thus far been conducted. 24,27 A 2019 multicenter study obtained a high negative predictive value of FDG PET/CT in clinically noted N0 status of the neck sides of patients with head and neck SCC after imaging via MRI and/or CT. 28 However, the preselection used in the study impedes general conclusions as to the diagnostic accuracy of FDG PET/CT and does not reveal whether this procedure can replace stand-alone morphologic imaging.…”

Targeting fibroblast activation protein in newly diagnosed squamous cell carcinoma of the oral cavity – initial experience and comparison to [18F]FDG PET/CT and MRI

“…Due to the high glucose consumption of tumor cells, [ 18 F] FDG is the reference tool for molecular imaging of squamous cell carcinoma of the head and neck and has proven its clinical value in a number of trials with high sensitivity and acceptable specificity [13][14][15][16][17][18]41]. A recent multi-center trial including 23 different imaging sites in the US prospectively evaluated the value of [ 18 F]FDG PET/CT in patients with newly diagnosed, first-time, head and neck squamous cell carcinoma and confirmed the high negative predictive value of this imaging modality [42].…”

“…The utility of positron emission tomography/computed tomography (PET/CT) with [ 18 F]-fluorodeoxyglucose ([ 18 F] FDG) for staging malignancies of the head and neck is well documented [13][14][15][16][17][18]. However, specificity of [ 18 F]FDG is hampered by uptake in inflammatory cells such as neutrophils or macrophages [19].…”

Ultrasound in patients with treated head and neck carcinomas

“…[ 2 , 8 ] The results of the present study have the same recurrence rate as that of retrospective studies, [ 1 , 2 ] a prospective study, [ 8 ] and an observational study [ 7 ] but has not the same recurrence rate as that of a cross-sectional study, [ 4 ] retrospective studies, [ 10 , 11 ] a prospective study, [ 12 ] and case series. [ 13 ] The reasons for contradictory results are that the studies on the Turkish population [ 4 ] and German population [ 11 ] have included the small sample size and less follow-up time, the study on the Korean population [ 12 ] is a preoperative diagnostic study, the study on Dutch population [ 10 ] has included the large sample size, and case series on the North American population [ 13 ] has included follow-up time for 104 days only and not included data of distal metastasis (Table 7 ). The present study was successful in the detection of recurrence in follow-up period monitoring through neck ultrasound.…”