title: Positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior?
abstract: The capability of modern imaging techniques such as CT, MRI, US and US-guided fine-needle aspiration cytology (USgFNAC) to detect small tumour deposits is limited. Therefore, the detection of occult metastases in the clinically negative neck remains a diagnostic problem. One of the novel options to refine staging of head and neck cancer is [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET). To evaluate the diagnostic value of FDG-PET in the detection of occult malignant lymph nodes, we compared the results of FDG-PET with other diagnostic techniques and the histopathological outcome of 15 neck dissection specimens from 15 head and neck cancer patients with a clinically negative neck. Three sides contained metastases of squamous cell carcinoma. FDG-PET enabled detection of metastases in two sides, which were also detected by MRI or USgFNAC. FDG-PET and CT missed metastases in one patient, which were detected by both MRI and USgFNAC. In studies with a detailed examination of lymph nodes of a neck dissection, a low sensitivity of FDG-PET for the detection of occult lymph node metastases is found. It is unlikely that FDG-PET is superior in the detection of occult lymph node metastases in head and neck cancer patients with a palpably negative neck. The histopathological method used seems to be the most important factor for the differences in sensitivity in reported FDG-PET studies. New approaches such as the use of monoclonal antibodies labelled with a positron emitter may improve the results of PET in these patients.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Jolijn
authors.initials: J
authors.lastname: Brouwer
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: Emile F I
authors.initials: EF
authors.lastname: Comans
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D049268:Positron-Emission Tomography; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18