Value of SUVmax for the Prediction of Bone Invasion in Oral Squamous Cell Carcinoma

Abstract

In advanced oral squamous cell carcinoma (OSCC), accurate planning of surgical resection and reconstruction are crucial for outcome and postoperative function. For OSCC close to the maxilla or mandible, prediction of bone invasion is necessary. The aim of this study was to examine whether metabolic tumor imaging obtained by fluorodeoxyglucose positron emission tomography (FDG-PET) could enhance preoperative predictability of bone invasion. We performed an analysis of 84 treatment-naïve OSCCs arising from gum (upper and lower), hard palate, floor of mouth, and retromolar trigone treated at the University Hospital Zurich, Switzerland, who underwent wide local excision with free flap reconstruction between 04/2010 and 09/2018 and with available preoperative FDG-PET. Prediction of bone invasion by metabolic tumor imaging such as maximum standardized uptake value (SUVmax) was examined. On definitive histopathology, bone invasion was present in 47 of 84 cases (56%). The probability of bone infiltration increased with a higher pretherapeutic SUVmax in an almost linear manner. A pretherapeutic SUVmax of primary tumor below 9.5 ruled out bone invasion preoperatively with a high specificity (97.6%). The risk of bone invasion was 53.6% and 71.4% for patients with SUVmax between 9.5–14.5 and above 14.5, respectively. Patients with bone invasion had worse distant metastasis-free survival compared to patients without bone invasion (log-rank test, p = 0.032). In conclusion, metabolic tumor imaging using FDG-PET could be used to rule out bone invasion in oral cancer patients and may serve in treatment planning.

Implications of Standardized Uptake Values of Oral Squamous Cell Carcinoma in PET-CT on Prognosis, Tumor Characteristics and Mitochondrial DNA Heteroplasmy

“…In line with previous studies demonstrating a correlation between metabolic activity, survival and clinicopathological features in OSCC [ 48 , 49 , 51 , 52 ], we were able to confirm these findings in the present study. Analysis of SUVmax values among patients with OSCC—divided into two groups according to a statistically calculated cut-off value—showed highly significant differences in survival, with higher survival rates in the low SUVmax group.…”

“…These results indicate a dependency between the local metabolic activity of tumors as seen by PET-CT and histopathological characteristics of the tumor, which are consistent with previous results [35]. According to Stalder et al [52], we also found a strong relationship between SUVmax and the presence of bone infiltration in our study collective [52]. These results, as well as the statistically significant correlation between grading and UICC, indicate that undifferentiated tumors also tend to grow faster and more aggressively with respect to their metabolic activity [38,39,47].…”

Predictive value of suvmax changes between two sequential post-therapeutic FDG-pet in head and neck squamous cell carcinomas

“…Further parameters such as total lesion glycolysis (TLG) or metabolic tumor volume (MTV) were not assessed. However, in previous studies [8][9][10] we showed that SUVmax was the metabolic parameters with the strongest predictive value.…”

Histometabolic Tumor Imaging of Hypoxia in Oral Cancer: Clinicopathological Correlation for Prediction of an Aggressive Phenotype

“…Their role in predicting radio-oncological outcomes has now also been demonstrated ( 9 , 34 – 38 ). However, a growing body of evidence shows that these data could also be used as a predictive tool for outcomes deemed to be surgical ( 39 ), such as occult lymph node metastasis ( 11 ), bone infiltration in OSCC ( 40 ), or organ preservation in laryngeal and hypopharyngeal cancer ( 41 , 42 ). Our study reinforces and confirms the prognostic role of SUV max as a surrogate marker for surgical outcomes.…”