Article Figures & Data
Figures
- FIGURE 1.
Pretreatment and posttreatment 18F-FDG PET (A and C) and corresponding MR (B and D) images of 63-y-old man with squamous cell carcinoma on left buccal mucosa. (A) 18F-FDG PET image shows intense focal accumulation of 18F-FDG (SUV = 5.59 mg/mL) in tumor before therapy (arrows). (B) Tumor is also visualized on postcontrast fat-suppression T1-weighted MR image (B) but not on CT image. (C) After chemoradiotherapy, 18F-FDG PET image reveals normalization of 18F-FDG uptake (arrows; SUV = 2.80 mg/mL), consistent with histologic finding of no viable tumor cells (PCR). (D) MR image still shows contrast enhancement in tumor although it is reduced in size (arrows), which may suggest residual tumor (false-positive). On basis of PET findings, patient avoided surgery. He has remained tumor free for >4 y.
- FIGURE 2.
Pretreatment (A and B) and posttreatment (C and D) images of 60-y-old man with large squamous cell carcinoma (T4 N2a M0) on left mandibular gingiva. Pretreatment 18F-FDG PET image (A) shows focus of high 18F-FDG accumulation (SUV = 12.77 mg/mL) on left mandible (arrows), consistent with postcontrast CT (arrows, B) findings. After chemoradiotherapy, tumor disappeared on visual inspection with slight induration. (C) Posttreatment 18F-FDG PET image shows no abnormal 18F-FDG accumulation (arrows; SUV = 3.11 mg/mL), consistent with histologic finding (PCR). (D) CT image shows remarkable reduction in tumor size but does not exclude residual tumor because of contrast enhancement (arrows). According to 18F-FDG PET findings, patient successfully underwent functional neck dissection and marginal resection of mandible, requiring neither continuous resection of mandible nor reconstructive surgery.
- FIGURE 3.
Pretreatment (A and B) and posttreatment (C and D) neck images of 78-y-old man with squamous cell carcinoma (T2 N0 M0) on floor of mouth. Pretreatment PET (A) and corresponding postcontrast CT (B) images demonstrate no metastasis to neck lymph nodes. (C) After chemoradiotherapy, neck lymph nodes were not palpable and posttreatment PET image shows abnormal 18F-FDG uptake in neck region (arrows, false-positive) probably due to inflammatory and reactive change. (D) Posttreatment CT image shows small lymph node (<1 cm; arrows, true-negative) in neck region, suggesting no metastasis. Patient was confirmed to have no metastasis in neck by clinical follow-up for >3 y.
Tables
- TABLE 1
Patient Characteristics and Imaging Results Evaluated for Primary Tumors Before Treatment
Patient no. Age (y) Sex Location TNM Pre-SUV* Interpretation confidence rating 67Ga scintigraphy CT MRI PET 1 63 F Tongue T4 N2b M0 7.85 0 4 4 4 2 85 F Tongue T2 N0 M0 4.17 0 0 0 4 3 71 M Tongue T2 N0 M0 10.56 0 0 0 4 4 50 M Tongue T4 N1 M0 14.12 3 4 4 4 5 63 M Floor of mouth T2 N0 M1† 5.92 4 4 4 4 6 66 M Buccal mucosa T3 N2b M0 5.07 3 4 4 4 7 70 M Maxillary gingiva T2 N0 M0 7.96 0 4 3 4 8 73 F Maxillary gingiva rT1 N0 M0 5.29 1 3 3 4 9 71 F Tongue T2 N0 M0 4.07 0 0 3 4 10 47 M Lower lip T2 N1 M0 11.22 0 1 2 4 11 51 M Mandible T4 N1 M0 7.28 3 4 4 4 12 66 M Tongue T2 N0 M0 5.15 0 1 2 3 13 48 M Mandibular gingiva T2 N1 M0 7.70 4 2 2 4 14 74 M Floor of mouth T3 N1 M0 14.54 4 4 4 4 15 60 M Mandibular gingiva T4 N2a M0 12.77 3 4 4 4 16 68 M Palatal mucosa T1 N0 M0 9.76 0 — 3 4 17 63 M Buccal mucosa T3 N0 M0 5.59 0 0 3 4 18 51 F Tongue T2 N0 M0 8.54 0 4 4 4 19 64 M Mandibular gingiva T4 N0 M0 8.40 3 4 3 4 20 71 M Floor of mouth T2 N0 M0 6.60 — 3 3 4 21 58 M Mandibular gingiva T4 N0 M0 11.34 — 4 4 4 22 56 M Floor of mouth T4 N0 M0 26.10 0 4 3 4 23 78 M Floor of mouth T2 N0 M0 10.46 — 3 3 4 Average score 1.4 2.8 3.0 4.0 - TABLE 3
Histologic Findings and Imaging Results Evaluated for Primary Tumors and Lymph Nodes After Treatment
Patient no. Histologic evaluation for primary tumors after chemoradiotherapy Post-SUV* Interpretation confidence rating for images after chemoradiotherapy CT (primary) MRI (primary) PET (primary) CT (LN) MRI (LN) PET (LN) 1 RD 4.41 3 — 3 2 — 2 2 PCR 4.84 — — 1 — — 2 3 PCR 3.16 1 0 1 2 2 3 4 RD 4.39 2 3 3 1 2 0 5 PCR 4.90 4 3 3 3 2 3 6 PCR 4.25 1 4 1 2 3 4 7 PCR 2.76 3 2 0 1 1 0 8 PCR 4.77 3 3 3 2 1 1 9 PCR 1.81 2 2 0 0 0 0 10 PCR 1.12 0 1 0 2 1 0 11 RD 5.02 4 3 3 3 2 0 12 PCR 2.87 — — 1 — — 1 13 PCR 3.52 2 3 0 2 2 2 14 PCR 2.80 3 3 1 2 2 2 15 PCR 3.11 3 3 2 3 3 2 16 PCR 3.80 0 0 0 2 1 0 17 PCR 2.80 1 3 0 2 1 0 18 RD 8.32 3 3 4 3 3 3 19 PCR 3.53 4 3 1 0 1 3 20 PCR 1.61 1 1 1 1 0 0 21 PCR 2.76 4 3 0 3 1 1 22 PCR 4.61 2 3 0 2 2 0 23 PCR 1.56 0 1 0 2 1 3 ↵* Post-SUV = posttreatment SUV.
LN = lymph nodes; RD = residual disease.
Grading system: grade 0 = definitely no tumor; grade 1 = probably no tumor; grade 2 = equivocal; grade 3 = probable tumor; grade 4 = definite tumor.
- TABLE 4
Sensitivity and Specificity of Posttreatment Images for Primary Tumors and Lymph Nodes
Parameter CT (primary) MRI (primary) PET (primary) CT (LN) MRI (LN) PET (LN) True-positive (n) 3 3 4 False-negative (n) 1 0 0 True-negative (n) 10 7 17 16 17 17 False-positive (n) 7 10 2 5 3 6 Sensitivity (%) 75 100 100 95% CI* (%) 22–99 31–100 40–100 Specificity (%) 59 41 89 76 85 74 95% CI* (%) 33–81 19–67 65–98 52–91 61–96 51–89 ↵* 95% Confidence interval (15).
LN = lymph nodes.
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