Positron emission tomography in the evaluation of stage III and IV head and neck cancer.
BACKGROUND
Detection of metastatic disease in head and neck cancer patients is critical to preoperative planning, because patients with distant metastasis will not benefit from surgical therapy. Conventional radiographic modalities, such as CT and MR, give excellent anatomic detail but poorly identify unenlarged lymph nodes harboring metastatic disease.


OBJECTIVE
A pilot study was conducted to evaluate the usefulness of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) detection of metastatic disease in patients with advanced-stage head and neck cancer.


METHODS
Total body FDG-PET imaging was performed in a prospective manner on 12 consecutive patients with a new diagnosis of stage III or IV mucosal squamous cell carcinoma of the head and neck. Chest CT was also performed on all 12 patients. Patients found to have metastatic disease on either CT or PET imaging underwent procedures to obtain histopathologic confirmation of disease.


RESULTS
Three patients (25%) had FDG-PET scans demonstrating metastatic disease. Two of these patients had no evidence of disease on chest radiograph or chest CT but were noted to have positive FDG-PET imaging within the mediastinal lymphatics. Mediastinoscopy was performed confirming metastatic disease in these patients. The third patient had a peripheral lung lesion detected on chest radiograph, CT, and FDG-PET. This nodule was diagnosed by CT-guided biopsy as squamous cell carcinoma.


CONCLUSIONS
FDG-PET scanning detected mediastinal disease in two patients (17%) with advanced-stage head and neck squamous cell carcinoma that was not identified with conventional imaging techniques. PET imaging seems to have significant potential in the detection of occult metastatic disease, particularly in the mediastinal lymphatics.
Teknos
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Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor Veterans Administration Hospital, 1904 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0312, USA. teknos@umich.edu
Rosenthal
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Lee
D
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Taylor
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Marn
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CS
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary*; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18