title: Comparison between PET and PET/CT in recurrent head and neck cancer and clinical implications.
abstract: The aim of this retrospective study was to compare the diagnostic accuracy between positron emission tomography (PET) and combined PET/computed tomography (PET/CT) in the detection of recurrent head and neck squamous cell carcinoma (HNSCC) and to evaluate the degree of interobserver agreement. Thirty-two patients who had undergone curative treatment for HNSCC and who presented with a suspicion of recurrent local disease were studied with fluoro-2-deoxy-D-glucose (FDG)-PET imaging. All patients had undergone an inconclusive conventional workup (nasofibroscopy, CT scan and/or MRI). PET and PET/CT were reviewed by two nuclear medicine physicians independently. Performances of PET and PET/CT were compared using biopsy and/or clinical follow-up of at least 8 months as gold-standard. ROC curves were employed for statistical analysis. Out of 32 patients, 18 (56%) had a local recurrence. Intraclass correlation coefficients were strong (>90) and statistically significant (P < 0.0001) for the two reviewers in all cases. The sensitivity, specificity and accuracy of PET were found to be 94%, between 36 and 50% and between 69 and 75%, respectively, depending on the consideration of equivocal cases. Results for PET/CT were found to be 94, 57 and 78%. The utility scores of PET and PET/CT were 0.72 and 0.78, respectively. PET/CT could have a direct impact on patient care with the avoidance of 8/14 (57%) unnecessary invasive procedures (panendoscopy under general anaesthesia). Combined PET/CT is more accurate than PET alone for detection of recurrent HNSCC. The findings of this study are reinforced by the strong interobserver agreement in the interpretation of the results.
authors.affiliation: Department of Head and Neck Surgery and Federation of Otolaryngology, La Timone University Hospital Center, Marseille Cedex 05, France. nfakhry@yahoo.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fakhry
authors.forename: David
authors.initials: D
authors.lastname: Lussato
authors.forename: Thierry
authors.initials: T
authors.lastname: Jacob
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Antoine
authors.initials: A
authors.lastname: Giovanni
authors.forename: Michel
authors.initials: M
authors.lastname: Zanaret
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D015588:Observer Variation; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed