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Staging of Untreated Squamous Cell Carcinoma of Buccal Mucosa with 18F-FDG PET: Comparison with Head and Neck CT/MRI and Histopathology

Tzu-Chen Yen, MD, PhD1,2, Joseph Tung-Chieh Chang, MD, MHA2,3, Shu-Hang Ng, MD2,4, Yu-Chen Chang, MD1,2, Sheng-Chieh Chan, MD1,2, Hung-Ming Wang, MD2,5, Lai-Chu See, PhD2,6, Tsung-Ming Chen, MD2,7, Chung-Jan Kang, MD2,7, Yi-Fen Wu, BS1,2, Kun-Ju Lin, MD, PhD1,2 and Chun-Ta Liao, MD2,7

1 Department of Nuclear Medicine, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
2 Taipei Chang Gung Head & Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
3 Department of Radiation Oncology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
4 Department of Diagnostic Radiology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
5 Department of Hema-Oncology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
6 Biostatistics Consulting Center/Department of Public Health, Chang Gung University, Taoyuan, Taiwan
7 Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan



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  		FIGURE 1. Trial profile. CCRT = concurrent chemotherapy and radiation therapy.

 


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  		FIGURE 2. Distribution of lymphadenopathy in 51 BSCC patients with nodal metastasis.

 


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  		FIGURE 3. A 52-y-old patient with left buccal cancer, T3 N2b M0. (A) Transaxial T2-weighted MR image reveals enlarged neck lymph node at left level IB (arrow). (B) Transaxial 18F-FDG PET image shows 18F-FDG-avid lesion at same level (arrow). Subsequent nodal dissection showed a metastatic node at level IB.

 


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  		FIGURE 4. A 51-y-old man who presented with left buccal cancer, T2 N0 M0. (A) Transaxial T2-weighted MR image reveals 2 benign neck lymph nodes at bilateral level IB (arrows). Two equivocal neck nodes are also noted, posterior to submandibular glands of level II (arrowheads). (B) Corresponding 18F-FDG PET image at same level reveals faintly 18F-FDG-avid lesions (arrow and arrowheads), which supported neck nodes being benign. Histopathologic examination was negative after neck dissection. He was well 1 y after surgery.

 


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  		FIGURE 5. Kaplan-Meier plots of locoregional control according to PET use for untreated BSCC.

 




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