title: FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma.
abstract: OBJECTIVE
  Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck.
  
  
  METHODS
  Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85%) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings.
  
  
  RESULTS
  FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96% (26 of 27) and 98.5% (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (kappa 0.95, 95% confidence interval 0.82-0.99) than for CT alone (kappa 0.81, 95% confidence interval 0.63-0.91; p = 0.06 by two-sided McNemar's testing).
  
  
  CONCLUSIONS
  These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA 98108, USA. docdls@u.washington.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Schwartz
authors.forename: Eric
authors.initials: E
authors.lastname: Ford
authors.forename: Joseph
authors.initials: J
authors.lastname: Rajendran
authors.forename: Bevan
authors.initials: B
authors.lastname: Yueh
authors.forename: Marc D
authors.initials: MD
authors.lastname: Coltrera
authors.forename: Jeffery
authors.initials: J
authors.lastname: Virgin
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Anzai
authors.forename: David
authors.initials: D
authors.lastname: Haynor
authors.forename: Barbara
authors.initials: B
authors.lastname: Lewellyn
authors.forename: David
authors.initials: D
authors.lastname: Mattes
authors.forename: Juergen
authors.initials: J
authors.lastname: Meyer
authors.forename: Mark
authors.initials: M
authors.lastname: Phillips
authors.forename: Michael
authors.initials: M
authors.lastname: Leblanc
authors.forename: Paul
authors.initials: P
authors.lastname: Kinahan
authors.forename: Kenneth
authors.initials: K
authors.lastname: Krohn
authors.forename: Janet
authors.initials: J
authors.lastname: Eary
authors.forename: George E
authors.initials: GE
authors.lastname: Laramore
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18