Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up

Abstract

In NPC patients, MRI appears to be superior to PET/CT for the assessment of locoregional invasion and retropharyngeal nodal metastasis. PET/CT is more accurate than MRI for determining cervical nodal metastasis and should be the better reference for the neck status. PET/CT has an acceptable diagnostic yield and a low false-positive rate for the detection of distant malignancy and can replace conventional work-up to this aim. PET/CT and head-and-neck MRI are suggested for the initial staging of NPC patients.

Meta-analysis of diagnostic value of 18F-FDG PET or PET/CT for detecting lymph node and distant metastases in patients with nasopharyngeal carcinoma

“…13 With regard to distant metastasis, PET/CT has an acceptable diagnostic yield and a low false-positive rate for the detection of distant malignancy and can replace conventional work-up for this aim. 10,14,15 To our knowledge, the results of previous studies are controversial, mainly because of different study design, selection criteria and reference standard. Thus, we performed a metaanalysis of all available studies to comprehensively assess their value in detecting lymph node and distant metastases in patients with NPC.…”

“…PET or PET/CT did not have adequate contrast resolution to identity retropharyngeal lymph nodes that merged with adjacent primary tumour or to discriminate direct tumour invasion from metastases, which may result in incorrect N staging or improper use of chemotherapy. 10 However, 18 F-FDG PET/CT may be more accurate than conventional work-up for the determination of neck status and identifying cervical lymph node metastasis, which could facilitate a more appropriate treatment plann, especially for portal designation. [10][11][12] For those suspicious lymph nodes on conventional imaging or PET/CT, pathological examination may still be necessary.…”

“…10 However, 18 F-FDG PET/CT may be more accurate than conventional work-up for the determination of neck status and identifying cervical lymph node metastasis, which could facilitate a more appropriate treatment plann, especially for portal designation. [10][11][12] For those suspicious lymph nodes on conventional imaging or PET/CT, pathological examination may still be necessary. Ultrasound-guided fine-needle aspiration, allowing cytological examination of suspicious nodes as small as 2 mm in diameter, may be a minimally invasive procedure that can enable cytological examination of suspicious lymph nodes.…”

“…MRI appeared to be superior to PET/CT in delineating primary tumour extent. 10 The use of PET/CT without MRI may lead to inappropriate coverage by radiation portals or improper use of chemotherapy. PET or PET/CT did not have adequate contrast resolution to identity retropharyngeal lymph nodes that merged with adjacent primary tumour or to discriminate direct tumour invasion from metastases, which may result in incorrect N staging or improper use of chemotherapy.…”

“…After reviewing the title and abstract, we excluded 556 obviously irrelevant articles. For the remaining 99 articles, we read full texts, and 18 articles 10,12,14,15,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] consisting 20 studies fulfilled all inclusion criteria and were included for data analysis.…”