Skip to main content

Advertisement

Log in

Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

To evaluate the diagnostic accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) relative to computed tomography (CT) for detecting metastatic cervical lymph nodes in patients with squamous cell carcinoma of the head and neck (HNSCC), and to ascertain the factors that affect this accuracy.

Methods

A total of 1076 lymph nodes obtained from 35 neck dissections in 26 HNSCC patients who preoperatively underwent both FDG-PET and CT were retrospectively analyzed. For pathological metastatic lymph nodes, the lymph node size (short-axis diameter), the ratio of intranodal tumor deposits, and the size of intranodal tumor deposits (maximum diameter of metastatic foci in each lymph node) were histologically recorded.

Results

Forty-six lymph nodes from 23 neck sides were pathologically diagnosed metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET evaluated individually per neck side were 74%, 92%, 80%, 94%, and 65%, respectively, whereas those of CT were 78%, 58%, 71%, 78%, and 58%, respectively. FDG-PET detected 100% of metastatic lymph nodes ≥10 mm, intranodal tumor deposits ≥9 mm, and intranodal tumor deposits with a ratio >75%, whereas no nodes or tumor deposits smaller than 5 mm were detected. The spatial resolution limitations of FDG-PET were responsible for 16 of 20 (80%) false-negative PET results in lymph nodes.

Conclusions

FDG-PET is a useful tool for preoperative evaluation of the neck because it accurately detects metastatic lymph nodes ≥10 mm and has fewer false-positive cases than CT. The high specificity of FDG-PET for lymph node metastases may play an important role in avoiding unnecessary neck dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Platz H, Fries R, Hudec M. Retrospective DOSAK study on carcinomas of the oral cavity: results and consequences. J Maxillofac Surg 1985;13:147–153.

    Article  PubMed  CAS  Google Scholar 

  2. Mafee MF, Valvassori GE, Becker M. Imaging of the head and neck. 2nd ed. In: Becker M, editor. Other infrahyoid neck lesions. New York: Thieme; 2005. p. 788–794.

    Google Scholar 

  3. Chen J, Cheong JH, Yun MJ, Kim J, Lim JS, Hyung WJ, et al. Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography. Cancer 2005;103:2383–2390.

    Article  PubMed  Google Scholar 

  4. Bar-Shalom R, Valdivia AY, Blaufox MD. PET imaging in oncology. Semin Nucl Med 2000;30:150–185.

    Article  PubMed  CAS  Google Scholar 

  5. Muylle K, Castaigne C, Flamen P. 18F-fluoro-2-deoxy-d-glucose positron emission tomographic imaging: recent developments in head and neck cancer. Curr Opin Oncol 2005;17:249–253.

    Article  PubMed  CAS  Google Scholar 

  6. Braams JW, Pruim J, Freling NJ, Nikkels PG, Roodenburg Jl, Boering G, et al. Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MRI. J Nucl Med 1995;36:211–216.

    PubMed  CAS  Google Scholar 

  7. Adams S, Baum RP, Stuckensen T, Bitter K, Hor G. Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 1998;25:1255–1260.

    Article  PubMed  CAS  Google Scholar 

  8. Paulus P, Sambon A, Vivegnis D, Hustinx R, Moreau P, Collignon J, et al. 18FDG-PET for the assessment of primary head and neck tumors: clinical, computed tomography, and histopathological correlation in 38 patients. Laryngoscope 1998;108:1578–1583.

    Article  PubMed  CAS  Google Scholar 

  9. Kitagawa Y, Sadato N, Azuma H, Ogasawara T, Yoshida M, Ishii Y, et al. FDG-PET to evaluate combined intra-arterial chemotherapy and radiotherapy of head and neck neoplasms. J Nucl Med 1999;40:1132–1137.

    PubMed  CAS  Google Scholar 

  10. Stuckensen T, Kovacs AF, Adams S, Baum RP. Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 2000;28:319–324.

    PubMed  CAS  Google Scholar 

  11. Kresnik E, Mikosch P, Gallowitsch HJ, Kogler D, Wieser S, Heinisch M, et al. Evaluation of head and neck cancer with 18F-FDG PET: a comparison with conventional methods. Eur J Nucl Med 2001;28:816–821.

    Article  PubMed  CAS  Google Scholar 

  12. Hannah A, Scott AM, Tochon-Danguy H, Chan JG, Akhurst T, Berhangieri S, et al. Evaluation of 18F-fluorodeoxyglucose positron emission tomography and computed tomography with histopathologic correlation in the initial staging of head and neck cancer. Ann Surg 2002;2:208–217.

    Article  Google Scholar 

  13. Kitagawa Y, Nihizawa S, Sano K, Ogasawara T, Nakamura M, Sadato N, et al. Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med 2003;44:198–206.

    PubMed  Google Scholar 

  14. Kitagawa Y, Sano K, Nishizawa S, Nakamura M, Ogasawara T, Sadato N, et al. FDG-PET for prediction of tumour aggressiveness and response to intra-arterial chemotherapy and radiotherapy in head and neck cancer. Eur J Nucl Med Mol Imaging 2003;30:63–71.

    Article  PubMed  CAS  Google Scholar 

  15. Ng SH, Yen TC, Liao CT, Chang JTC, Chan SC, Ko SF, et al. 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 2005;46:1136–1143.

    PubMed  Google Scholar 

  16. Dobert N, Kovacs AF, Menzel C, Hamscho N, Yuen H, Engels K, et al. The prognostic value of FDG PET in head and neck cancer: correlation with histopathology. Q J Nucl Med Mol Imaging 2005;49:253–257.

    PubMed  CAS  Google Scholar 

  17. Myers LL, Wax MK. Positron emission tomography in the evaluation of the negative neck in patients with oral cavity cancer. J Otolaryngol 1998;27:342–347.

    PubMed  CAS  Google Scholar 

  18. Hyde NC, Prvulovich E, Newman L, Waddington WA, Visvikis D, Ell P. A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography. Oral Oncol 2003;39:350–360.

    Article  PubMed  CAS  Google Scholar 

  19. Brouwer J, de Bree R, Comans EFI, Castelijns JA, Hoekstra OS, Leemans CR. Positron emission tomography using [18F] fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior? Eur Arch Otorhinolaryngol 2004;261:479–483.

    Article  PubMed  Google Scholar 

  20. Wensing BM, Vogel WV, Marres HA, Merkx MA, Postema EJ, Oyen WJ, et al. FDG-PET in the clinically negative neck in oral squamous cell carcinoma. Laryngoscope 2006;116:809–813.

    Article  PubMed  Google Scholar 

  21. Crippa F, Leutner M, Belli F, Gallino F, Greco M, Pilotti S, et al. Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med 2000;41:1491–1494.

    PubMed  CAS  Google Scholar 

  22. Takamochi K, Yoshida J, Murakami K, Niho S, Ishii G, Nishimura M, et al. Pitfalls in lymph node staging with positron emission tomography in non-small cell lung cancer patients. Lung Cancer 2005;47:235–242.

    Article  PubMed  Google Scholar 

  23. Mijnhout GS, Hoekstra OS, van Lingen A, van Diest PJ, Ader HJ, Lammertsma AA, et al. How morphometric analysis of metastatic load predicts the (un) usefulness of PET scanning: the case of lymph node staging in melanoma. J Clin Pathol 2003;56:283–286.

    Article  PubMed  CAS  Google Scholar 

  24. Hamakawa H, Takemura K, Sumida T, Kayahara H, Tanioka H, Sogawa K. Histological study on pN upgrading of oral cancer. Virchows Arch 2000;437:116–121.

    Article  PubMed  CAS  Google Scholar 

  25. Stoeckli SJ, Pfaltz M, Steinert H, Schmid S. Histopathological features of occult metastasis detected by sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma. Laryngoscope 2002;112:111–115.

    Article  PubMed  Google Scholar 

  26. Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41:1369–1379.

    PubMed  CAS  Google Scholar 

  27. Schöder H, Yeung HWD, Gonen M, Kraus D, Larson SM. Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 2004;231:65–72.

    Article  PubMed  Google Scholar 

  28. Schöder H, Carlson DL, Kraus DH, Stambuk HE, Gonen M, Erdi YE, et al. 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med 2006;47:755–762.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yutaka Yamazaki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yamazaki, Y., Saitoh, M., Notani, Ki. et al. Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer. Ann Nucl Med 22, 177–184 (2008). https://doi.org/10.1007/s12149-007-0097-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-007-0097-9

Keywords

Navigation