Elsevier

Clinical Positron Imaging

Volume 2, Issue 4, July–August 1999, Pages 197-204
Clinical Positron Imaging

Diagnostic Accuracy of F-18 FDG-PET in the Assessment of Posttherapeutic Recurrence of Head and Neck Cancer

https://doi.org/10.1016/S1095-0397(99)00023-0Get rights and content

Abstract

The purpose of this study was to compare whole-body fluorine-18-fluorodeoxyglucose positron emission tomography (F-18 FDG-PET) with conventional imaging modalities (CI: CT/MRI) in the detection of recurrent head and neck cancer. Whole-body F-18 FDG-PET was performed in 45 patients (recurrence = 39; no recurrence = 16) with previous head and neck cancer. We compared detectability by the period from initial cancer treatment and treatment modalities. Thirty were PET-positive and 15 were PET-negative. The sensitivity, specificity, and accuracy of PET were 97%, 88%, and 93%, respectively (corresponding figures of CI were 73%, 85%, and 77%). In 18 patients who underwent PET less than 3 months after the completion of cancer treatment, the sensitivity, specificity, and accuracy were 100%, 86%, and 94%, while for CI, the corresponding figures were 67%, 71%, and 69%. In 18 patients who had undergone surgery, PET results were 14 true positive and 4 were true negative; significantly higher detectability than CI. Among the patients who were evaluated for more than 6 months or treated by radiotherapy without surgery, diagnostic accuracy was almost the same. Whole body F-18 FDG-PET was a valuable tool in the evaluation of post-therapeutic recurrence of head and neck cancer.

Introduction

Modern local treatments of head and neck cancer consist of radiation therapy and/or radical neck dissection.1 For patients with local recurrence, second courses of high-dose radiation therapy are usually recommended and the time interval between the original treatment and the recurrence is prognostically significant.2 Wang et al.3 obtained good results in high-dose re-irradiation therapy of recurrent nasopharyngeal cancer; in patients who received 6000cGy or more, the reported 5-year survival rate was 45%.

Cancer treatments can cause a variety of posttreatment changes such as tissue edema, loss of tissue planes, fibrosis, scarring, and asymmetry and these can make MRI, CT, or laryngoscopic evaluation difficult.4 In anatomical imaging modalities, lymph node involvement has been based on size, but this does not always accurately reflect the real situation. When using CT to assess cervical lymph node metastasis, the overall error rate was 7.5–28%; using MRI, the rate was 16%, and by palpation, 20–28%.5 Even fine-needle biopsy may miss viable tumor tissue, though early detection of recurrence is crucial if salvage therapy is to be initiated.6 In addition, it has been reported that 10% of head and neck cancer patients had second primary malignancy in upper aerodigestive tract.6

F-18 FDG-PET can image regional glucose metabolism, noninvasively and independently of anatomical change. F-18 FDG-PET has been successfully applied to a variety of malignant tumors, including those present in the brain, lung, musculoskeletal system, pancreas, and breast.7, 8, 9, 10, 11 Laubenbacher et al.12 and McGuirt et al.13 reported that F-18 FDG-PET was useful for the detection of occult primary tumor and metastatic lymph nodes of the head and neck. Minn et al.14 found that FDG uptake was associated with the proliferative activity of malignant head and neck tumors. There have, however, been few reports on the application of F-18 FDG-PET in posttherapeutic patients with head and neck cancer.

The purpose of this study was to evaluate the diagnostic accuracy of F-18 FDG-PET in the detection of recurrent head and neck cancer (Figure 1).

Section snippets

Patients

The records of 45 patients (34 males and 11 females) with head and neck cancer were examined. Their primary tumors consisted of 13 nasopharyngeal cancers, 7 laryngeal cancers, 10 oral cavity cancers, 3 hypopharyngeal cancers, and 12 other tumors. Their mean age was 51.0 ± 15.4 years, and all had been treated at Seoul National University Hospital or Samsung Medical Center between 1994 and 1997. Recurrence after surgery and/or radiotherapy and/or chemotherapy was suspected clinically. Their

Results

Patient characteristics and the results of F-18 FDG-PET are summarized in Table 1. Among 29 of 45 patients with recurrent disease, local recurrence without the involvement of other tumor sites was noted in 10(34%), loco-regional recurrence in 13(45%), and distant metastasis in 9(31%). Distant metastasis without regional recurrence was found in 5 patients (17%), while 16 of 45 (36%) were tumor-free.

The FDG-PET findings were positive in 30 patients and negative in 15; sensitivity, specificity,

Discussion

Because techniques for the treatment of head and neck cancer have improved, recurrence must be detected accurately.5 Because of post-therapeutic fibrosis, extensive edema, anatomical alteration, and asymmetry after surgery and radiotherapy, conventional imaging modalities and laryngoscopic evaluation for the detection of recurrence are difficult. Moreover, there are possibilities of distant metastasis and second primary malignancy of the upper aerodigestive tract.

On physical examination,

Conclusion

For the detection of recurrence in head and neck cancer, whole-body F-18 FDG-PET was more accurate than conventional imaging modalities. The sensitivity and accuracy of F-18 FDG-PET were higher than those of CI. Whole-body F-18 FDG-PET enabled early detection of recurrence more accurately in patients who underwent surgery than in those patients who were evaluated for recurrence with CI.

Acknowledgements

The authors thank Mr. Kyu Jin Cho and Mr. In Won Lee for their technical assistance. This work has been supported by a grant of the 1997 Good Health Project from the Ministry of Health and Welfare, Republic of Korea.

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