F-18 FDG-PET as a routine surveillance tool for the detection of recurrent head and neck squamous cell carcinoma
Introduction
The successful salvage treatment of head and neck squamous cell carcinoma (HNSCC) patients requires earlier and more accurate detection of recurrence. During the first year after treatment, many physicians perform monthly follow-up examinations, including physical examinations and structural imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). Due to anatomical changes induced by therapy, which may be further obscured by flap reconstruction, however, this method has been found to be too equivocal in detecting recurrence.1, 2, 3, 4, 5, 6
Positron emission tomography (PET) with 2-[F-18] fluoro-2-dexoy-d-glucose (FDG) is an imaging modality based on tissue metabolism rather than anatomic constructs to detect tumors. After Minn et al.7 showed that FDG-PET could differentiate responder to radiation therapy from non-responder, use of FDG-PET scans has grown rapidly in oncology and in the assessment of HNSCC.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16
Several reports have shown that PET scan is a useful tool to distinguish recurrent tumors from post-treatment changes. Populations of these studies, however, were mainly patients with clinically suspicion for recurrence2, 3, 4, 5 and/or prospective cohorts with PET scan at fixed time intervals within 12 months after the end of treatment.8, 9, 10, 11 Additionally, few systematic follow-up studies testing the use of routine PET scans relative to time interval, especially long term interval, have been studied for subclinical patients with no evidence of recurrence. Thus, to our knowledge, there is no consensus regarding the interval and frequency of PET scans for surveillance of recurrence of HNSCC in subclinical patients after treatment. We therefore retrospectively evaluated the accuracy and predictive value of routine PET scans relative to time interval after completion of treatment, in order to evaluate their efficacy and proper timing for surveillance of recurrent HNSCC in subclinical patients.
Section snippets
Subjects
From January 2001 to December 2004, 422 patients with HNSCC were admitted and underwent treatment in our institution. A review of these patients showed that PET scans were performed in 189 patients after completion of treatment to detect residual cancer or recurrence. We excluded 12 patients with inadequate clinical follow-up or metastatic work-up, as well as 18 patients who underwent PET scans to determine their therapeutic responses within 2 months after completion of radiation- or
Overall accuracy and predictive value
Of total 206 events with PET scan, 80 (38.8%) were locoregional recurrence and/or distant metastasis/secondary malignancy. The diagnostic accuracy of conventional evaluations and PET scans are summarized in Table 3. The overall sensitivity and negative predictive value of PET scans for the diagnosis of recurrence were 92.5% and 94.8%, respectively. In contrast, those of conventional methods were only 55.0% and 76.9%, respectively. The overall diagnostic sensitivity, negative predictive value,
Discussion
Our study showed FDG-PET was more sensitive and accurate in detecting recurrent HNSCC than conventional evaluation methods. Patients with recurrent HNSCC who undergo salvage surgery at early stages have a 70% 2-year relapse-free survival (RFS) rate, whereas those with recurrent, advanced-stage HNSCC have just a 22% 2-year RFS rate after salvage surgery.6 Thus, the earlier and more accurate detection of recurrent HNSCC is critically important for achieving successful salvage treatment. Our
Conclusions
With its high sensitivity and negative predictive value, PET scan may be a useful tool for routine surveillance for detection of recurrence of HNSCC in subclinical patients. For routine surveillance, the initial PET scan should be performed within 6 months after completion of treatment and the proper timing of next routine PET scan for subclinical patient with initial negative PET result might be 1 year after initial PET scan.
Disclosures
The authors have no disclosures to report.
Acknowledgement
Grant support: This work was supported by the Ministry of Science and Technology, Republic of Korea, Grant No. M10414030002-05N1403-00240.
References (18)
- et al.
Early evaluation of the response to radiotherapy of patients with squamous cell carcinoma of the head and neck using 18FDG-PET
Oral Oncol
(2005) - et al.
Potential doubling time and clinical outcome in head and neck squamous cell carcinoma treated with 70 GY in 7 weeks
Int J Radiat Oncol Biol Phys
(1996) - et al.
PET scanning in head and neck oncology: a review
Head Neck
(1998) - et al.
Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2-18F-fluoro-2-deoxy-d-glucose positron emission tomography
Laryngoscope
(1999) - et al.
Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient
Laryngoscope
(2000) - et al.
Usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with a residual structural abnormality after definitive treatment for squamous cell carcinoma of the head and neck
Head Neck
(2004) - et al.
Clinical usefulness of 18F-FDG PET in nasopharyngeal carcinoma patients with questionable MRI findings for recurrence
J Nucl Med
(2004) - et al.
Diagnostic and prognostic value of [18F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma
J Clin Oncol
(2002) - et al.
Evaluation of treatment response to radiotherapy in head and neck cancer with fluorine-18 fluorodeoxyglucose
J Nucl Med
(1988)
Cited by (47)
Parathyroid Imaging: Four-dimensional Computed Tomography, Sestamibi, and Ultrasonography
2021, Neuroimaging Clinics of North AmericaCorrelation between PET/CT and CT in the staging prior to the treatment of head and neck squamous cell carcinoma
2021, Brazilian Journal of OtorhinolaryngologyFDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls
2017, Seminars in Nuclear Medicine18F FDG PET/CT and head and neck cancer: Patient management and outcomes
2015, PET ClinicsCitation Excerpt :FDG-PET/CT has an advantage of providing functional information and leads to a lesser number of equivocal reports compared to other forms of conventional imaging. FDG-PET/CT scan considered a useful tool in routine surveillance for detection of recurrence in subclinical HNC patients due to its high sensitivity and NPV.79 Several studies suggested that performing FDG-PET/CT during follow-up could add value to clinical assessment.
Elective neck dissection versus observation for cN0 neck of squamous cell carcinoma primarily located in the maxillary gingiva and alveolar ridge: A retrospective study of 129 cases
2013, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :Our experience supported an aggressive policy for neck management rather than observation, in view of high potential risk of metastasis. It has been suggested that positron emission tomography and computed tomography with 18F-fludeoxyglucose (18F-FDG PET/CT imaging) might be more accurate than CT or magnetic resonance imaging in identifying cervical lymph node metastases in head and neck SCC,22 and in one study the diagnostic sensitivity and specificity for regional recurrence were 90% and 91%, respectively.23 Our previous study found that single-photon emission computed tomography (SPECT) with a complex of technetium 99m (V) meso-2,3-dimercaptosuccinic acid (99mTc (V)-DMSA SPECT imaging) has fairly high affinity with metastatic lymph nodes in the neck, especially in the cN0 patients, and is helpful for designing proper neck dissection.