The diagnostic value of positron emission tomography (PET) with radiolabelled fluorodeoxyglucose (¹⁸F-FDG) in head and neck cancer

Abstract

Positron emission tomography (PET) scanning has recently been introduced into clinical practice but its usefulness in the management of head and neck cancer is not well defined. The aim of this prospective preliminary study was to examine the clinical value of fluorodeoxyglucose (FDG) – PET in patients with head and neck cancer treated by radiotherapy with surgery in reserve by (i) relating quantitative uptake of isotope to tumour type and histological grade and (ii) comparing the imaging findings of PET and magnetic resonance imaging (MRI) in post-radiotherapy assessment of tumour response. Twenty-one patients had pre-treatment PET and MRI scans and these were repeated four and eight months after treatment if there was no clinical relapse. Pre-treatment uptake of FDG using tumour to cerebellar ratio parameters was significantly related to the histological grade of squamous cancer (p = 0.04) but not to tumour type. Discordance of post-treatment PET/MRI findings in one case indicates a possible role for PET in the early detection of tumour recurrence. Other potential uses of PET scanning in the management of head and neck cancer are discussed.

Comparison of FLT-PET and FDG-PET for Visualization of Head and Neck Squamous Cell Cancers

“…Similarly, with FDG SUVs in poorly and moderately grade lesions were significantly higher than in well differentiated counterparts. Several reports have shown FDG accumulation to be lower in well-and moderately differentiated tumours than in poorly differentiated HNSCCs [18,19]. Recently, Kameyama et al reported FLT SUV in poorly differentiated tumours to be significantly higher than in well and moderately differentiated gastric cancers [20].…”

PET Changes Management and Improves Prognostic Stratification in Patients with Head and Neck Cancer: Results of a Multicenter Prospective Study

“…Although validation of sites of malignancy was not part of this trial design, the accuracy of PET in staging head and neck cancer has been extensively reported in the literature (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)23). Information from referring clinicians as well as from radiology and PET reports was used for lesion evaluation, and no centralized review of the imaging was made.…”

“…Several studies have evaluated the use of PET in the initial staging of head and neck cancer (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). 18 F-FDG PET may offer advantages over anatomic imaging in the assessment of primary tumors, as it can detect superficial or submucosal primary tumor infiltration without adjacent tissue deformation, and nodal disease (1,2).…”

Imaging of lymphadenopathy in the neck

“…Westhofen showed that US FNAC was superior to CT in detecting neck recurrences after previous treatment [76]. Recently, Anzai et al [81], Slevin et al [82], and Li et a. [83] showed that positron emission tomography is more sensitive than CT and MRI in detecting early recurrences.…”