PT  - JOURNAL ARTICLE
AU  - Luke Sonoda
AU  - Subhadip Ghosh-Ray
AU  - Korinna Karamagkioli
AU  - Tina Mistry
AU  - Mohamed Khalifa
AU  - Kyoko Sonoda
AU  - Wendy Sookram
AU  - Damion Melsome
TI  - Accuracy of 18F-FDG-PET-CT in assessing local bony/cartilaginous involvement by head & neck cancers
DP  - 2014 May 01
TA  - Journal of Nuclear Medicine
PG  - 1525--1525
VI  - 55
IP  - supplement 1
4099  - http://jnm.snmjournals.org/content/55/supplement_1/1525.short
4100  - http://jnm.snmjournals.org/content/55/supplement_1/1525.full
SO  - J Nucl Med2014 May 01; 55
AB  - 1525 Objectives 18F-FDG-PET-CT plays an important role in the management of head and neck cancers. In particular, presence/absence of local osseous invasion is an important factor in T-staging and determining treatment options. This study aimed to determine the accuracy of PET-CT in prediction of local osseous invasion by head and neck cancers. Methods A retrospective analysis of 771 PET-CT scans of head and neck cancers (oral/nasal cavity, pharynx, larynx) in 6-years-period (2008-2013) was performed. Four main indications of scans were: staging of high risk of disseminated disease (297), cervical nodal metastases of unknown primary (74), suspected disease recurrence (177), and assessment of therapeutic response (223). Final diagnosis of osseous involvement was determined by histopathology, clinical and imaging follow-up. Results PET-CT scans demonstrated increased abnormal osseous uptake in 63 cases, of which 52 were true osseous invasion, but 11 were false-positive (4 due to osteoradionecrosis, 4 benign dental infection/inflammation, 3 over-staging due to intense FDG-uptake nearby the bone). 708 cases were reported as ‘no osseous uptake’, of which 704 were true-negative, but 4 were false-negative (2 due to intrinsically low FDG-avid primary disease and bony lesions were not significantly FDG-avid, 2 due to bony necrosis of tumour with no significant FDG-uptake). Sensitivity, specificity, PPV, NPV and accuracy of PET-CT in detecting local osseous invasion are 93, 98, 83, 99 and 98% respectively. Conclusions 18F-FDG-PET-CT plays an important role in detecting local osseous invasion by head and neck cancers, with an accuracy of 98%. Important false-positives are due to benign causes such as infection and osteroradionecrosis, and due to intense FDG-uptake nearby the bone. If there is clinical doubt further investigations including MRI and biopsy should be performed.