Staging of head and neck tumors: [18F]fluorodeoxyglucose positron emission tomography compared with physical examination and conventional imaging modalities.
OBJECTIVE
The aims of this study were to evaluate the use of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) in the staging of primary and recurrent tumors of the head and neck in comparison to routine clinical methods (physical examination, ultrasonography, computed tomography) and to investigate the effect of FDG-PET scanning on therapeutic strategy.


METHODS
Retrospective analysis of the results of FDG-PET and conventional diagnostic modalities were compared with biopsy results or patient outcome or both. In a period of 6 years, 78 FDG-PET studies were performed on 56 patients; 24 of them before therapy and 54 on suspicion of residual or recurrent tumor. The evaluation of the diagnostic results was performed separately for the primary site and the nodal sites of the neck and for tumor occurrence in the trunk.


RESULTS
In detecting the primary site, FDG-PET results reached a sensitivity of 93%, a specificity of 100%, and an accuracy of 94%. In detecting the nodal sites, similar results of 94%, 97%, and 96% were seen, respectively. In detecting tumor occurrence in the trunk, results were 83%, 100%, and 98%, respectively. The McNemar test did not prove any statistically significant difference between FDG-PET and the evaluated conventional methods. When used in conjunction with conventional diagnostic tests, 22% of the PET scans gave important additional information. Finally, 11% of the performed PET scans led to a change in therapeutic planning.


CONCLUSIONS
Our results show that FDG-PET is a reliable method to detect tumors in all tumor sites. Therefore, we recommend that FDG-PET scanning be performed routinely as a first diagnostic step in pretherapeutic staging of patients with biopsy-proven head and neck cancer.
Sigg
Martin Beat
MB
Clinic of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
Steinert
Hans
H
Grätz
Klaus
K
Hugenin
Pia
P
Stoeckli
Sandro
S
Eyrich
Gerold Klaus
GK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology; D016009:Chi-Square Distribution; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18