Abstract
Background
18F-fludeoxyglucose (FDG) positron emission tomography (PET) is a sensitive and specific method for detecting active residual disease after chemoradiotherapy or radiotherapy, but few studies have accurately evaluated its diagnostic accuracy with histopathologic correlation. We therefore investigated the clinical utility of 18F-FDG PET/computed tomography (CT) in patients undergoing salvage surgery for residual head and neck squamous cell carcinoma (HNSCC) after primary nonsurgical treatments.
Methods
Thirty-nine patients who initially received chemotherapy (n = 23), radiotherapy (n = 3), or chemoradiotherapy (n = 13) were evaluated 8–28 weeks later by 18F-FDG PET/CT and CT/magnetic resonance imaging (MRI) prior to salvage surgery to clear residual disease. These results were compared with those of histopathologic analysis of the primary tumor and neck dissection tissue samples.
Results
Of these 39 patients, 22 (56%) had residual primary tumor. The sensitivity, specificity and accuracy of 18F-FDG PET/CT for detecting primary tumors were 91, 65, and 79%, respectively. Of 56 dissected heminecks, 37 (66%) had residual metastatic lymph nodes. 18F-FDG PET/CT and CT/MRI had accuracies for positive heminecks of 91 and 75%, respectively (P = 0.004). On a cervical level-by-level-based analysis, 18F-FDG PET/CT and CT/MRI had accuracies of 89 and 78%, respectively (P < 0.001); 18F-FDG PET/CT had a specificity of 93% and a negative-predictive value of 92% for detection of positive levels.
Conclusions
18F-FDG PET/CT is superior to CT/MRI in detecting residual nodal disease in head and neck squamous cell carcinoma patients undergoing salvage surgery. Accurate preoperative diagnosis using 18F-FDG PET/CT may help to determine the extent of salvage surgery.
Similar content being viewed by others
References
Choong N, Vokes E. Expanding role of the medical oncologist in the management of head and neck cancer. CA Cancer J Clin. 2008;58:32–53.
Langerman A, Plein C, Vokes EE, et al. Neck response to chemoradiotherapy: complete radiographic response correlates with pathologic complete response in locoregionally advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 2009;135:1133–6.
Bussink J, van Herpen CM, Kaanders JH, Oyen WJ. PET-CT for response assessment and treatment adaptation in head and neck cancer. Lancet Oncol. 2010;11:661–9.
Velázquez RA, McGuff HS, Sycamore D, Miller FR. The role of computed tomographic scans in the management of the N-positive neck in head and neck squamous cell carcinoma after chemoradiotherapy. Arch Otolaryngol Head Neck Surg. 2004;130:74–7.
Tan A, Adelstein DJ, Rybicki LA, et al. Ability of positron emission tomography to detect residual neck node disease in patients with head and neck squamous cell carcinoma after definitive chemoradiotherapy. Arch Otolaryngol Head Neck Surg. 2007;133:435–40.
Inohara H, Enomoto K, Tomiyama Y, et al. The role of CT and (18)F-FDG PET in managing the neck in node-positive head and neck cancer after chemoradiotherapy. Acta Otolaryngol. 2009;129:893–9.
Passero VA, Branstetter BF, Shuai Y, et al. Response assessment by combined PET-CT scan versus CT scan alone using RECIST in patients with locally advanced head and neck cancer treated with chemoradiotherapy. Ann Oncol. 2010;21:2278–83.
Ong SC, Schöder H, Lee NY, et al. Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for Locoregional advanced head and neck cancer. J Nucl Med. 2008;49:532–40.
Yao M, Smith RB, Hoffman HT, et al. Clinical significance of postradiotherapy [18F]-fluorodeoxyglucose positron emission tomography imaging in management of head-and-neck cancer-a long-term outcome report. Int J Radiat Oncol Biol Phys. 2009;74:9–14.
Porceddu SV, Jarmolowski E, Hicks RJ, et al. Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo)radiotherapy in head and neck cancer. Head Neck. 2005;27:175–81.
Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology–Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002;128:751–8.
Som PM, Curtin HD, Mancuso AA. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. Am J Roentgenol. 2000;174:837–44.
Kitagawa Y, Nishizawa S, Sano K, et al. Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67 Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med. 2003;44:198–206.
Greven KM, Williams DW 3rd, McGuirt WF Sr, et al. Serial positron emission tomography scans following radiation therapy of patients with head and neck cancer. Head Neck. 2001;23:942–6.
Isles MG, McConkey C, Mehanna HM. A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol. 2008;33:210–22.
Andrade RS, Heron DE, Degirmenci B, et al. Posttreatment assessment of response using FDG-PET/CT for patients treated with definitive radiation therapy for head and neck cancers. Int J Radiat Oncol Biol Phys. 2006;65:1315–22.
Fukui MB, Blodgett TM, Snyderman CH, et al. Combined PET-CT in the head and neck: part 2. Diagnostic uses and pitfalls of oncologic imaging. Radiographics. 2005;25:913–30.
Gourin CG, Boyce BJ, Williams HT, Herdman AV, Bilodeau PA, Coleman TA. Revisiting the role of positron-emission tomography/computed tomography in determining the need for planned neck dissection following chemoradiation for advanced head and neck cancer. Laryngoscope. 2009;119:2150–5.
Stoeckli SJ, Steinert H, Pfaltz M, Schmid S. Is there a role for positron emission tomography with 18F-fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma. Head Neck. 2002;24:345–9.
Ng SH, Yen TC, Liao CT, 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;46:1136–43.
Yamazaki Y, Saitoh M, Notani K, et al. Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer. Ann Nucl Med. 2008;22:177–84.
Roh JL, Yeo NK, Kim JS, et al. Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography and positron emission tomography/computed tomography imaging in the preoperative staging of head and neck squamous cell carcinoma. Oral Oncol. 2007;43:887–93.
Yao M, Smith RB, Graham MM, et al. The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment. Int J Radiat Oncol Biol Phys. 2005;63:991–9.
Peters LJ, Weber RS, Morrison WH, Byers RM, Garden AS, Goepfert H. Neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy. Head Neck. 1996;18:552–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, S.Y., Kim, J.S., Yi, J.S. et al. Evaluation of 18F-FDG PET/CT and CT/MRI with Histopathologic Correlation in Patients Undergoing Salvage Surgery for Head and Neck Squamous Cell Carcinoma. Ann Surg Oncol 18, 2579–2584 (2011). https://doi.org/10.1245/s10434-011-1655-x
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-1655-x