title: Identification of distant metastases with positron-emission tomography-computed tomography in patients with previously untreated head and neck cancer.
abstract: OBJECTIVE
  To investigate the utility of positron-emission tomography-computed tomography (PET-CT) in identifying distant metastatic disease in patients with previously untreated head and neck squamous cell cancer (HNSCC) prior to definitive treatment.
  
  
  METHODS
  Retrospective analysis of 27 consecutive patients with previously untreated HNSCC who underwent PET-CT imaging in addition to chest radiography (CXR) as part of their metastatic workup.
  
  
  RESULTS
  The majority of patients (89%) had TNM stage III or IV disease. PET-CT was suspicious for pulmonary malignancy in four (15%) patients and indeterminate in one (4%) patient. CXR was suspicious for pulmonary malignancy in two (7%) patients. Pulmonary metastases or a new lung primary was present in 3 (11%) patients: 3 of 4 (75%) patients with positive PET-CT scans and 0 of 23 (0%) patients with negative or indeterminate PET-CT scans compared with 2 of 2 (100%) patients with positive CXR and 1 of 25 (4%) patients with negative CXR. The sensitivity and specificity of PET-CT in predicting pulmonary malignancy was 100% and 96%, respectively, with a positive predictive value of 75% and a negative predictive value of 100%. The sensitivity and specificity of CXR in predicting pulmonary malignancy was 67% and 100%, respectively, with a positive predictive value of 100% and a negative predictive value of 96%. Including nonpulmonary sites, the overall incidence of distant metastatic disease was 19% (5/27) with 11% (3/27) unsuspected prior to PET-CT.
  
  
  CONCLUSIONS
  PET-CT improves detection of metastatic disease in the high-risk patient and should be performed as part of the routine pretreatment evaluation of patients with advanced stage HNSCC.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia, USA. cgourin1@jhmi.edu
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: Tammara L
authors.initials: TL
authors.lastname: Watts
authors.forename: Hadyn T
authors.initials: HT
authors.lastname: Williams
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Patel
authors.forename: Paul A
authors.initials: PA
authors.lastname: Bilodeau
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Coleman
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary*; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18