HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH RSS TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: jnumed.107.044792v1 49/4/532    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JNM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ong, S. C. Articles by Kraus, D. H. Search for Related Content PubMed PubMed Citation Articles by Ong, S. C. Articles by Kraus, D. H.

Clinical Utility of ¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; ² Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York; ³ Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; ⁴ Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; and ⁵ Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

Correspondence: For correspondence or reprints contact: Heiko Schöder, MD, Department of Radiology/Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 77, New York, NY 10021. E-mail: schoderh{at}mskcc.org

For patients with locoregional advanced head and neck squamous cell carcinoma (HNSCC), concurrent chemoradiotherapy is a widely accepted treatment, but the need for subsequent neck dissection remains controversial. We investigated the clinical utility of ¹⁸F-FDG PET/CT in this setting. Methods: In this Institutional Review Board (IRB)–approved and Health Insurance Portability and Accountability Act (HIPPA)–compliant retrospective study, we reviewed the records of patients with HNSCC who were treated by concurrent chemoradiation therapy between March 2002 and December 2004. Patients with lymph node metastases who underwent ¹⁸F-FDG PET/CT 8 wk after the end of therapy were included. ¹⁸F-FDG PET/CT findings were validated by biopsy, histopathology of neck dissection specimens (n = 18), or clinical and imaging follow-up (median, 37 mo). Results: Sixty-five patients with a total of 84 heminecks could be evaluated. ¹⁸F-FDG PET/CT (visual analysis) detected residual nodal disease with a sensitivity of 71%, a specificity of 89%, a positive predictive value (PPV) of 38%, a negative predictive value (NPV) of 97%, and an accuracy of 88%. Twenty-nine heminecks contained residual enlarged lymph nodes (diameter, 1.0 cm), but viable tumor was found in only 5 of them. ¹⁸F-FDG PET/CT was true-positive in 4 and false-positive in 6 heminecks, but the NPV was high at 94%. Fifty-five heminecks contained no residual enlarged nodes, and PET/CT was true-negative in 50 of these, yielding a specificity of 96% and an NPV of 98%. Lack of residual lymphadenopathy on CT had an NPV of 96%. Finally, normal ¹⁸F-FDG PET/CT excluded residual disease at the primary site with a specificity of 95%, an NPV of 97%, and an accuracy of 92%. Conclusion: In patients with HNSCC, normal ¹⁸F-FDG PET/CT after chemoradiotherapy has a high NPV and specificity for excluding residual locoregional disease. In patients without residual lymphadenopathy, neck dissection may be withheld safely. In patients with residual lymphadenopathy, a lack of abnormal ¹⁸F-FDG uptake in these nodes also excludes viable tumor with high certainty, but confirmation of these data in a prospective study may be necessary before negative ¹⁸F-FDG PET/CT may become the only, or at least most-decisive, criterion in the management of the neck after chemoradiotherapy.

Key Words: ¹⁸F-FDG PET/CT • head and neck cancer • neck dissection • chemoradiotherapy

^* Contributed equally to this work.

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

Related articles in JNM:

This Month in JNM

JNM 2008 49: 11A-12A. [Full Text]  

This article has been cited by other articles:

				J. P. Malone, M. A. T. Gerberi, S. Vasireddy, L. F. Hughes, K. Rao, B. Shevlin, M. Kuhn, D. Collette, J. Tennenhouse, and K. T. Robbins Early Prediction of Response to Chemoradiotherapy for Head and Neck Cancer: Reliability of Restaging With Combined Positron Emission Tomography and Computed Tomography Arch Otolaryngol Head Neck Surg, November 1, 2009; 135(11): 1119 - 1125. [Abstract] [Full Text] [PDF]

				H. Schoder, M. Fury, N. Lee, and D. Kraus PET Monitoring of Therapy Response in Head and Neck Squamous Cell Carcinoma J. Nucl. Med., May 1, 2009; 50(Suppl_1): 74S - 88S. [Abstract] [Full Text] [PDF]