High incidence of chest malignancy detected by FDG PET in patients suspected of recurrent squamous cell carcinoma of the upper aerodigestive tract.
OBJECTIVE
To determine the incidence of chest neoplasms detected by FDG PET in patients with previously treated squamous cell head and neck cancer (HNC), being evaluated for possible recurrent disease.


METHODS
This is a retrospective review of 41 patients (M = 29, F = 12: average age = 58 years) with previously treated HNC who underwent FDG PET of the neck and chest as part of routine evaluation for locoregional and/or distant recurrence. Thirty-four of 41 patients had advanced stage III or IV HNC. All FDG PET studies were reviewed by dedicated nuclear medicine physicians, including evaluation for abnormal uptake in the chest. The chest FDG findings were correlated with serial chest radiographs or chest CT. The occurrence rate of incidental chest malignancy was determined and based on characteristic imaging findings, biopsy, and/or clinical course.


RESULTS
Twelve of 41 patients had abnormal FDG uptake in the lungs and/or mediastinum. Ten of 12 patients were found to have neoplasms that could represent either metastases or a new lung primary. Five of these 10 were unsuspected neoplasms prior to FDG PET. The other 2/12 FDG PET scans in the chest were false positive. There was one false-negative FDG PET, with subsequent PET and CT demonstrating pulmonary metastases. Overall, there was a 27% incidence of chest malignancies in patients with advanced HNC being evaluated for possible recurrence.


CONCLUSIONS
Our study demonstrated a chest malignancy in 1 out of 4 patients with advanced HNC being evaluated for locoregional and/or distant spread. Fifty percent were unsuspected prior to FDG PET. This result suggests that FDG PET of the lungs should be routinely included in the evaluation of high-risk patients.
Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Alain
A
Perlow
Chuong
C
Bui
Paul
P
Shreve
Pia C
PC
Sundgren
Theodoros N
TN
Teknos
Suresh K
SK
Mukherji
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18