Clinical utility of (18)F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced head and neck cancer Journal Article


Authors: Ong, S. C.; Schoder, H.; Lee, N. Y.; Patel, S. G.; Carlson, D.; Fury, M.; Pfister, D. G.; Shah, J. P.; Larson, S. M.; Kraus, D. H.
Article Title: Clinical utility of (18)F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced head and neck cancer
Abstract: For patients with locoregional advanced head and neck squamous cell carcinoma (HNSCC), concurrent chemoradiotherapy is a widely accepted treatment, but the need for subsequent neck dissection remains controversial. We investigated the clinical utility of 18F-FDG PET/CT in this setting. Methods: In this Institutional Review Board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant retrospective study, we reviewed the records of patients with HNSCC who were treated by concurrent chemoradiation therapy between March 2002 and December 2004. Patients with lymph node metastases who underwent 18F-FDG PET/CT ≥ 8 wk after the end of therapy were included. 18F-FDG PET/CT findings were validated by biopsy, histopathology of neck dissection specimens (n = 18), or clinical and imaging follow-up (median, 37 mo). Results: Sixty-five patients with a total of 84 heminecks could be evaluated. 18F-FDG PET/CT (visual analysis) detected residual nodal disease with a sensitivity of 71%, a specificity of 89%, a positive predictive value (PPV) of 38%, a negative predictive value (NPV) of 97%, and an accuracy of 88%. Twenty-nine heminecks contained residual enlarged lymph nodes (diameter, ≥ 1.0 cm), but viable tumor was found in only 5 of them. 18F-FDG PET/CT was true-positive in 4 and false-positive in 6 heminecks, but the NPV was high at 94%. Fifty-five heminecks contained no residual enlarged nodes, and PET/CT was truenegative in 50 of these, yielding a specificity of 96% and an NPV of 98%. Lack of residual lymphadenopathy on CT had an NPV of 96%. Finally, normal 18F-FDG PET/CT excluded residual disease at the primary site with a specificity of 95%, an NPV of 97%, and an accuracy of 92%. Conclusion: In patients with HNSCC, normal 18F-FDG PET/CT after chemoradiotherapy has a high NPV and specificity for excluding residual locoregional disease. In patients without residual lymphadenopathy, neck dissection may be withheld safely. In patients with residual lymphadenopathy, a lack of abnormal 18F-FDG uptake in these nodes also excludes viable tumor with high certainty, but confirmation of these data in a prospective study may be necessary before negative 18F-FDG PET/CT may become the only, or at least most-decisive, criterion in the management of the neck after chemoradiotherapy. Copyright © 2008 by the Society of Nuclear Medicine, Inc.
Keywords: cancer chemotherapy; retrospective studies; major clinical study; histopathology; neck dissection; squamous cell carcinoma; cisplatin; fluorouracil; multimodality cancer therapy; treatment duration; cancer radiotherapy; combined modality therapy; positron emission tomography; follow up; lymph node metastasis; lymphatic metastasis; diagnostic accuracy; carboplatin; computer assisted tomography; tomography, x-ray computed; tumor biopsy; pathology; retrospective study; diagnostic agent; head and neck cancer; head and neck neoplasms; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; medical record; scintiscanning; imaging; radiography; neck; lymphadenopathy; head and neck tumor; chemoradiotherapy; 18f-fdg pet/ct
Journal Title: Journal of Nuclear Medicine
Volume: 49
Issue: 4
ISSN: 0161-5505
Publisher: Society of Nuclear Medicine  
Date Published: 2008-04-01
Start Page: 532
End Page: 540
Language: English
DOI: 10.2967/jnumed.107.044792
PUBMED: 18344440
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 53" - "Export Date: 17 November 2011" - "CODEN: JNMEA" - "Source: Scopus"
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Seng Chuan Ong
    3 Ong
  2. Dennis Kraus
    268 Kraus
  3. Snehal G Patel
    414 Patel
  4. Diane Carlson
    52 Carlson
  5. Nancy Y. Lee
    884 Lee
  6. Heiko Schoder
    550 Schoder
  7. David G Pfister
    389 Pfister
  8. Matthew G Fury
    102 Fury
  9. Steven M Larson
    959 Larson
  10. Jatin P Shah
    724 Shah
Related MSK Work