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The Value of ¹⁸F-FDG PET in the Detection of Stage M0 Carcinoma of the Nasopharynx

¹ Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
² Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
³ Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
⁴ Institute of Nuclear Energy Research, Taoyuan, Taiwan

Distant metastasis is an important issue for nasopharyngeal carcinoma (NPC). The potential value of PET using ¹⁸F-FDG has not been well defined. This prospective study investigated the impact of ¹⁸F-FDG PET in NPC patients with stage M0 disease. Methods: From April 2001 to June 2003, 140 NPC patients (118 primary and 22 primary recurrent) with stage M0 (negative results from chest radiography, liver sonography, and whole-body bone scanning) underwent ¹⁸F-FDG PET to check for distant metastases. Confirmatory MRI or CT was performed if any abnormal ¹⁸F-FDG uptake was found at distant sites. The distant lesion was confirmed pathologically, if feasible, and was followed up clinically and with imaging for at least 6 mo. Results: ¹⁸F-FDG PET detected 26 true-positive metastatic sites in 18 (12.9%) of the 140 patients, among whom 14 had primary and 4 had recurrent tumors. The patient-based sensitivity and specificity of ¹⁸F-FDG PET for distant metastases were 100% and 86.9%, respectively. Mediastinal lymph nodes (n = 8) were the most common sites, followed by lung, liver, and bone (n = 5 each) and by other lymph nodes (n = 3). In patients with primary tumors, advanced nodal status (N2–3) was a statistically significant variable associated with development of distant metastases (P = 0.044). For recurrent NPC, neither age, sex, initial tumor stage, grade of differentiation, nor nodal stage showed a statistically significant difference between patients with and patients without distant metastases. Conclusion: ¹⁸F-FDG PET is valuable in avoiding aggressive locoregional radiotherapy in some NPC patients by the revelation of occult distant metastases, especially in patients with primary disease at a nodal stage of N2–3.

Key Words: ¹⁸F-FDG • PET • nasopharyngeal carcinoma • M0

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