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¹⁸F-FDG PET Can Replace Conventional Work-up in Primary M Staging of Nonkeratinizing Nasopharyngeal Carcinoma

¹ Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan; ² Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan; ³ Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan; ⁴ Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan; and ⁵ Department of Otorhinolaryngology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan

Correspondence: For correspondence or reprints contact: Tzu-Chen Yen, MD, PhD, Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, 199 Dunhua N. Rd., Taipei 10507, Taiwan. E-mail: yen1110{at}adm.cgmh.org.tw.

Conventional work-up (CWU) with chest radiography, abdominal ultrasonography, and skeletal scintigraphy has limited value in M staging of nonkeratinizing nasopharyngeal carcinoma (NPC). Our aim was to evaluate whether ¹⁸F-FDG PET could replace CWU by comparing their diagnostic efficacies. Methods: Patients with histologically proven nonkeratinizing NPC and no prior treatment were prospectively enrolled. All study participants underwent CWU and ¹⁸F-FDG PET for primary M staging. Distant metastasis was considered to be present if there was any reliable evidence identified within 1 y after diagnosis. The comparative diagnostic efficacies of ¹⁸F-FDG PET, CWU, and the combination of ¹⁸F-FDG PET and CWU (PET+CWU) were evaluated using the areas under the receiver-operating-characteristic (ROC) curves. Results: Sixty-one (20.3%) of 300 eligible patients were found to have distant metastases. On a patient-based analysis, ¹⁸F-FDG PET was found to be more effective than CWU (P < 0.001), whereas it was equally effective with PET+CWU (P = 0.130). On region-based analyses, ¹⁸F-FDG PET was more effective than skeletal scintigraphy and chest radiography for detecting bone metastases (P < 0.001) and chest metastases (P < 0.001), respectively. ¹⁸F-FDG PET and abdominal ultrasound were equally effective for detecting hepatic metastases (P = 0.127). On region-based analyses, the combination of ¹⁸F-FDG PET and CWU did not yield any noticeable increase in diagnostic efficacy. Conclusion: ¹⁸F-FDG PET can replace CWU in primary M staging of nonkeratinizing NPC.

Key Words: ¹⁸F-FDG PET • nasopharyngeal carcinoma • staging • distant metastasis

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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