18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI Journal Article


Authors: Schoder, H.; Carlson, D. L.; Kraus, D. H.; Stambuk, H. E.; Gonen, M.; Erdi, Y. E.; Yeung, H. W. D.; Huvos, A. G.; Shah, J. P.; Larson, S. M.; Wong, R. J.
Article Title: 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI
Abstract: 18F-FDG PET has a high accuracy in staging head and neck cancer, but its role in patients with clinically and radiographically negative necks (N0) is less clear. In particular, the value of combined PET/CT has not been determined in this group of patients. Methods: In a prospective study, 31 patients with oral cancer and no evidence of lymphnode metastases by clinical examination or CT/MRI underwent 18F-FDG PET/CT before elective neck dissection. PET/CT findings were recorded by neck side (left or right) and lymph node level. PET/CT findings were compared with histopathology of dissected nodes, which was the standard of reference. Results: Elective neck dissections (26 unilateral, 5 bilateral; a total of 36 neck sides), involving 142 nodal levels, were performed. Only 13 of 765 dissected lymph nodes harbored metastases. Histopathology revealed nodal metastases in 9 of 36 neck sides and 9 of 142 nodal levels.PET was TP in 6 nodal levels (6 neck sides), false-negative in 3 levels (3 neck sides), true-negative in 127 levels (23 neck sides), and false-positive in 6 levels (4 neck sides). The 3 false-negative findings occurred in metastases smaller than 3 mm or because of inability to distinguish between primary tumor and adjacent metastasis. TP and false-positive nodes exhibited similar standardized uptakes (4.8 ± 1.1 vs. 4.2 ± 1.0; P = not significant). Sensitivity and specificity were 67% and 85% on the basis of neck sides and 67% and 95% on the basis of number of nodal levels, respectively. If a decision regarding the need for neck dissection had been based solely on PET/CT, 3 false-negative necks would have been undertreated, and 4 false-positive necks would have been overtreated. Conclusion: 18F-FDGPET/CT can identify lymph node metastases in a segment of patients with oral cancer and N0 neck. A negative test can exclude metastatic deposits with high specificity. Despite reasonably high overall accuracy, however, the clinical application of PET/CT in the N0 neck may be limited by the combination of limited sensitivity for small metastatic deposits and a relatively high number of false-positive findings. The surgical management of the N0 neck should therefore not be based on PET/CT findings alone.
Keywords: adult; clinical article; controlled study; human tissue; aged; aged, 80 and over; middle aged; clinical trial; histopathology; neck dissection; cancer staging; nuclear magnetic resonance imaging; positron emission tomography; methodology; magnetic resonance imaging; lymph node metastasis; lymphatic metastasis; laboratory diagnosis; metastasis; computer assisted tomography; tomography, x-ray computed; diagnostic imaging; chemistry; drug uptake; head and neck cancer; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; neoplasm metastasis; iohexol; false positive reactions; radiodiagnosis; mouth neoplasms; mouth cancer; clinical examination; mouth tumor; 18f-fdg pet/ct; lymph node metastases; n0 neck
Journal Title: Journal of Nuclear Medicine
Volume: 47
Issue: 5
ISSN: 0161-5505
Publisher: Society of Nuclear Medicine  
Date Published: 2006-05-01
Start Page: 755
End Page: 762
Language: English
PUBMED: 16644744
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 84" - "Export Date: 4 June 2012" - "CODEN: JNMEA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Dennis Kraus
    268 Kraus
  2. Henry W D Yeung
    126 Yeung
  3. Mithat Gonen
    1031 Gonen
  4. Diane Carlson
    52 Carlson
  5. Hilda Stambuk
    48 Stambuk
  6. Heiko Schoder
    550 Schoder
  7. Richard J Wong
    419 Wong
  8. Yusuf E Erdi
    118 Erdi
  9. Steven M Larson
    959 Larson
  10. Jatin P Shah
    724 Shah
  11. Andrew G Huvos
    289 Huvos
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