title: Ability of positron emission tomography to detect residual neck node disease in patients with head and neck squamous cell carcinoma after definitive chemoradiotherapy.
abstract: OBJECTIVE
  To report our experience using the neck examination, computed tomography (CT), and positron emission tomography (PET) to clinically evaluate node-positive patients with head and neck squamous cell cancer for residual neck node disease after definitive chemoradiotherapy.
  
  
  METHODS
  Retrospective review of all Cleveland Clinic patients with head and neck squamous cell cancer and N2 or N3 neck node involvement at presentation who were treated with definitive concurrent chemoradiotherapy and who underwent clinical restaging after treatment using the neck examination, CT, and PET.
  
  
  METHODS
  Tertiary care referral institution.
  
  
  METHODS
  Forty-eight patients with 72 positive necks at diagnosis were followed up for a median of 20 months.
  
  
  METHODS
  Palpable nodes on examination, nodes larger than 1 cm, nodes with central necrosis on CT, or any hypermetabolic lymph nodes on PET were considered clinical evidence of residual nodal disease. The true rate of pathologic involvement was determined by histologic examination after planned neck dissection or if regional recurrence developed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for all 3 clinical assessment tools.
  
  
  RESULTS
  Planned neck dissection was performed in 33 necks and was positive for residual neck node disease in 5 necks. A delayed neck dissection was performed in 5 necks and was positive in 3 necks. The positive predictive value was low for all 3 clinical assessment tools. The addition of PET did not significantly improve the negative predictive value or positive predictive value of CT and the clinical examination.
  
  
  CONCLUSIONS
  Residual neck node disease after definitive chemoradiotherapy was infrequent and was not well predicted by PET. A positive PET finding in this setting is of little utility. Although a negative PET finding was highly predictive for control of neck disease after chemoradiotherapy, it added little to the clinical neck examination and CT.
authors.affiliation: Taussig Cancer Center, Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH 44195, USA. tana@ccf.org
authors.forename: Ann
authors.initials: A
authors.lastname: Tan
authors.forename: David J
authors.initials: DJ
authors.lastname: Adelstein
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Rybicki
authors.forename: Jerrold P
authors.initials: JP
authors.lastname: Saxton
authors.forename: Ramon M
authors.initials: RM
authors.lastname: Esclamado
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Wood
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lorenz
authors.forename: Marshall
authors.initials: M
authors.lastname: Strome
authors.forename: Marjorie A
authors.initials: MA
authors.lastname: Carroll
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18