Staging of untreated squamous cell carcinoma of buccal mucosa with 18F-FDG PET: comparison with head and neck CT/MRI and histopathology.
This prospective, nonrandomized, case-control study evaluated the impact of (18)F-FDG PET in staging untreated squamous cell carcinoma of the buccal mucosa (BSCC) and compared the results with CT/MRI and histopathology.


METHODS
Between January 2002 and April 2004, 102 untreated BSCC patients with cM0 (no evidence of distant metastatic focus on chest radiograph, liver ultrasonograph, and bone scan) were enrolled with either conventional work-up (CWU, n = 51) or PET (CWU+PET, n = 51). All were monitored for at least 6 mo. The comparative diagnostic efficacies of PET and CT/MRI were evaluated using the area under the receiver-operating-characteristic curve (AUC). The primary endpoint was the percentage reduction in futile surgery (preoperative detection of distant metastatic lesions). The secondary endpoint was the 2-y cumulative recurrence rate among study participants (with PET) compared with that of comparable control subjects (without PET).


RESULTS
Significant benefits of PET compared with those of CT/MRI for BSCC patients were in the detection of locoregional (AUC, 0.973 vs. 0.928; P = 0.026), regional (AUC, 0.939 vs. 0.837; P = 0.026), and level II (AUC, 0.974 vs. 0.717; P = 0.02) lymph nodes. Two percent (1/51) of the patients experienced a reduction in futile surgery in the CWU+PET group compared with 0% (0/51) in the CWU group. However, no statistical difference was found in the 2-y locoregional control rate between the CWU and the CWU+PET groups.


CONCLUSIONS
The role of (18)F-FDG PET for BSCC with cM0 is limited. Although PET is superior to CT/MRI in identifying cervical nodal metastases, it does not improve locoregional recurrence.
Yen
Tzu-Chen
TC
Department of Nuclear Medicine, Chang Gung Memorial Hospital Linkou Medical Center, 5 Fu-Shin Street, Kueishan, Taoyuan 133, Taiwan.
Chang
Joseph Tung-Chieh
JT
Ng
Shu-Hang
SH
Chang
Yu-Chen
YC
Chan
Sheng-Chieh
SC
Wang
Hung-Ming
HM
See
Lai-Chu
LC
Chen
Tsung-Ming
TM
Kang
Chung-Jan
CJ
Wu
Yi-Fen
YF
Lin
Kun-Ju
KJ
Liao
Chun-Ta
CT
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000000981:diagnostic imaging*; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18