18F-FDG PET Can Replace Conventional Work-up in Primary M Staging of Nonkeratinizing Nasopharyngeal Carcinoma
Feng-Yuan Liu 1,
Chien-Yu Lin 2,
Joseph T. Chang 2,
Shu-Hang Ng 3,
Shy-Chyi Chin 3,
Hung-Ming Wang 4,
Chun-Ta Liao 5,
Sheng-Chieh Chan 1,
and
Tzu-Chen Yen 1*
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
5 Department of Otorhinolaryngology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
* To whom correspondence should be addressed. E-mail: yen1110{at}adm.cgmh.org.tw.
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Abstract |
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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
