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Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

¹ Biomaging–INBEB and Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; ² Fundação Oswaldo Cruz and National Institute of Science and Technology in Structural Biology and Bioimaging–INBEB, Rio de Janeiro, Brazil; ³ Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; ⁴ Department of Radiology, University of Utah, Salt Lake City, Utah; ⁵ Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah; and ⁶ Department of Radiation Oncology, University of Utah, Salt Lake City, Utah

Correspondence: For correspondence or reprints contact: Kathryn A. Morton, Department of Radiology, University of Utah, 1A71 SOM, 50 N. Medical Dr., Salt Lake City, UT 84132. E-mail: kathryn.morton{at}hsc.utah.edu

The purpose of this study was to compare optimized whole-body (WB) and dedicated high-resolution contrast-enhanced PET/CT protocols and contrast enhanced CT in the preoperative staging of primary squamous cell carcinoma of the head and neck. Methods: A total of 44 patients with clinically M0 squamous cell carcinoma of the head and neck underwent primary tumor resection and neck dissection within 6 wk of diagnostic imaging. Imaging consisted of a standard WB PET/CT protocol without intravenous contrast enhancement, followed by a high-resolution dedicated head and neck (HN) PET/CT protocol, which included diagnostic-quality contrast-enhanced CT (CECT). Imaging results were compared with histopathology. A 5-point scale was used to designate primary tumor localization and the presence of lymph node metastasis on a per-patient and per-level basis. For cervical nodes, receiver-operating-characteristic curves were generated to determine the differences in performance between the WB and HN PET/CT protocols and CECT. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for primary tumor and cervical nodes. Results: No statistical difference was observed between WB and HN PET/CT protocols, both of which significantly outperformed CECT, in the evaluation of the primary tumor. The performance of the HN PET/CT protocol was superior to that of the WB PET/CT in the detection of cervical node metastases, achieving statistical significance on a per-level basis and approaching significance on a per-patient basis, with the greatest advantage in the detection of small positive lymph nodes (<15 mm). No significant difference was observed between the WB PET/CT protocol and CECT in nodal staging, either on a per-patient or on a per-level basis. Conclusion: The primary advantage of the dedicated HN PET/CT protocol over the WB protocol or CECT in the staging of head and neck cancer is in the detection of small lymph node metastases.

Key Words: positron emission tomography • computed tomography • head and neck cancer • squamous cell carcinoma • tumor staging

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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