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Prospective Comparison of FDG and FET PET/CT in Patients with Head and Neck Squamous Cell Carcinoma

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Abstract

Aim

The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC.

Materials and Methods

Twenty-seven patients (20 men and seven women, aged 48–76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings.

Results

Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p < 0.02) and specificity with FET (p < 0.01). The statistical level of significance was not reached at patient level.

Conclusion

Although its good specificity was confirmed, FET did not appear to be suited as a first-line PET tracer in HNSCC imaging and cannot replace FDG for staging due to insufficient sensitivity. However, it was useful in a few selected cases to favor a wait and see attitude when a FDG+ FET− focus was discovered in patients referred for systematic FDG PET during follow-up. In contrast, second primary cancers should not be ruled out if FDG was clearly positive in the lungs or the digestive tract.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hopital Tenon AP-HP and Université Pierre etMarie Curie, Paris, France

    S. Balogova, K. Kerrou, D. Grahek, F. Montravers & J. N. Talbot

  2. Department of Otorhinolaryngology, Hopital Tenon AP-HP and Université Pierre etMarie Curie, Paris, France

    S. Périé, B. Angelard, B. Susini, P. El Chater & J. Lacau St Guily

Authors
  1. S. Balogova
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  2. S. Périé
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  3. K. Kerrou
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  4. D. Grahek
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  5. F. Montravers
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  6. B. Angelard
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  7. B. Susini
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  8. P. El Chater
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  9. J. Lacau St Guily
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  10. J. N. Talbot
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Correspondence to S. Balogova.

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Balogova, S., Périé, S., Kerrou, K. et al. Prospective Comparison of FDG and FET PET/CT in Patients with Head and Neck Squamous Cell Carcinoma. Mol Imaging Biol 10, 364–373 (2008). https://doi.org/10.1007/s11307-008-0155-2

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  • DOI: https://doi.org/10.1007/s11307-008-0155-2

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