Article Figures & Data
Figures
- FIGURE 1.
Reader study. Number of indeterminate study results was reduced from 12.3% to 9.7%, with increase in negative study results from 70.1% to 72.2%.
- FIGURE 2.
Kaplan–Meier survival plots. PET 1 scans were performed 4–6 mo after treatment; PET 2 scans, 7–12 mo after treatment; and PET 3 scans, 13–24 mo after treatment. OS differed significantly between patients with PET/CT positive for tumor and patients with PET/CT negative for tumor.
- FIGURE 3.
Added value of PET/CT for clinical assessment. PET/CT was helpful for excluding tumor in 51.5% of patients who had clinical suspicion of recurrence or uncertainty and for identifying recurrence in 4.6% of patients with no prior clinical suspicion.
- FIGURE 4.
Negative PET/CT scan at 6–12 mo of follow-up. A 43-y-old man had TXN3M0 squamous cell carcinoma on right side of neck (arrows) that was strongly positive for p16 but HPV-16 negative. (A) Staging PET/CT did not identify primary site. Patient completed concurrent chemoradiation. He initially received cisplatin, docetaxel, and 5-fluorouracil with induction chemotherapy but had significant nausea, vomiting, and dehydration. He was then switched to carboplatin and 5-fluorouracil, which was dose-reduced to 650 mg/m2. (B) Follow-up PET/CT scan obtained using same views at 7 mo after therapy showed no evidence of recurrence.
- FIGURE 5.
No clinical suspicion. PET/CT identified nodal recurrence at 6–12 mo of follow-up in 61-y-old man diagnosed with T3N2c squamous cell carcinoma of right supraglottic larynx. (A) Baseline coronal PET, axial PET, and fused PET/CT (from left to right) demonstrated intense 18F-FDG activity in primary lesion (arrows), with locoregional disease in right neck. He received chemoradiation to total dose of 70 Gy. (B) PET/CT scan obtained using same views 4 mo after end of therapy revealed interval decrease in size and uptake in right supraglottic laryngeal area. Although some of this uptake could be inflammatory, findings were suggestive of residual disease. Subsequently, patient underwent suspension microscopic laryngoscopy with excision of right false vocal fold irregularity. Biopsy samples were read as negative. (C) However, follow-up PET/CT scan at 10 mo after therapy revealed 18F-FDG–avid right level III lymph node (arrows), biopsy of which was positive for disease.
- FIGURE 6.
Positive PET/CT scan at 12–24 mo of follow-up in 43-y-old man with history of T4N2bM0 squamous cell carcinoma of supraglottic larynx. (A) Baseline coronal and axial PET (bottom left), axial CT (top right), and fused PET/CT (bottom left) show supraglottic mass (arrows). Patient underwent laryngectomy and right neck dissection. He then completed course of cisplatin and radiation to 66 Gy. (B) At 13 mo after therapy, follow-up PET/CT, not presented here, showed locoregional recurrence in neck; maximum intensity projection 3-dimensional representation (left), axial CT (bottom right), and fused PET/CT (top right) sections showed metastatic disease to lung upper lobes (arrows).
Tables
Demographic Characteristic n Age (y)* <40 13 (9.7%) 41–60 72 (53.73%) >60 49 (36.56%) Sex Male 98 (73%) Female 36 (27%) Site of tumor Oropharynx 72 (53.7%) Oral cavity 23 (17.2%) Larynx 14 (10.44%) Nasopharynx 11 (8.2%) Other 14 (10.44%) HPV status Positive 55 (41.04%) Negative 13 (9.7%) Not available 14 (49.26%) Stage I 9 (6.7%) II 12 (8.95%) III 19 (14.17%) IV 82 (61.2%) Unknown primary 8 (5.79%) Undetermined stage 4 (2.98%) Primary treatment Radiotherapy 7 (5.2%) Chemoradiotherapy 75 (56%) Surgery 52 (38.8%) ↵* Mean ± SD, 57 ± 12 y.
HPV = human papillomavirus.
Biopsy or 3-mo follow-up PET/CT finding Positive Negative Total Positive 22 19 41 Negative 4 182 186 Total 26 201 227 Histopathology or 3-mo clinical follow-up was used as reference standard. Sensitivity, specificity, positive predictive value, and negative predictive value of follow-up PET/CT 4–24 months after treatment for HNSCC were 84.6%, 90.5%, 53.6%, and 97.8%, respectively.
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