Evaluation of 18 F-fluorodeoxyglucose positron emission tomography and computed tomography with histopathologic correlation in the initial staging of head and neck cancer.
OBJECTIVE
To prospectively evaluate the use of 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) in the initial staging of squamous cell head and neck carcinoma.


BACKGROUND
The status of cervical lymph nodes is an important prognostic factor and determinant of management approach in squamous cell head and neck cancer.


METHODS
FDG-PET findings were compared with those of computed tomography (CT) before removal of the primary tumor and/or neck dissection. Histopathologic analysis was used as the gold standard for assessment of the sensitivity and specificity of these modalities.


RESULTS
FDG-PET correctly identified the primary tumor in 35 of 40 patients in whom the site of the primary was known clinically and still present (sensitivity 88%). None of four unknown primaries were detected. Tumors not detected by FDG-PET were generally superficial, with depths of less than 4 mm. CT correctly identified 18 of the 35 primary tumors (sensitivity 51%). Eleven of 17 CT false-negative tumors were detected by FDG-PET. The sensitivity and specificity for the presence of metastatic neck disease on FDG-PET were 82% and 100%, respectively; those for CT were 81% and 81%, respectively. FDG-PET was true positive for metastatic neck disease in two of the three CT false-negative patients.


CONCLUSIONS
FDG-PET shows promise in the initial staging of head and neck cancer and provides additional accuracy to a conventional staging process using CT.
Hannah
Anthony
A
Centre for Positron Emission Tomography, Ludwig Institute for Cancer Research, Heidelberg, Victoria, Australia. kiwi@austin.unimelb.edu.au
Scott
Andrew M
AM
Tochon-Danguy
Henri
H
Chan
J Gordon
JG
Akhurst
Tim
T
Berlangieri
Salvatore
S
Price
David
D
Smith
Gerard J
GJ
Schelleman
Tony
T
McKay
W J
WJ
Sizeland
Andrew
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18