title: Comparison of 4 modalities for distant metastasis staging in endemic nasopharyngeal carcinoma.
abstract: BACKGROUND
  Endemic nasopharyngeal carcinoma (NPC) commonly metastasizes to the lungs, liver, and bones. This study aims to assess the efficacy of 4 distant metastasis staging modalities, namely (1) conventional work-up comprising chest X-ray, liver ultrasound, and skeletal scintigraphy, (2) CT of the thorax, abdomen, and skeletal scintigraphy, (3) (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET), and (4) integrated FDG-PET/CT.
  
  
  METHODS
  Seventy-eight consecutive patients diagnosed with NPC were enrolled and followed up for a minimum of 6 months to confirm the staging at diagnosis.
  
  
  RESULTS
  Six patients (7.7%) had distant metastases at diagnosis. The sensitivities and specificities of conventional work-up, combined CT and skeletal scintigraphy, FDG-PET, and FDG-PET/CT were 33.3%, 66.7%, 83.3%, and 83.3%; and 90.3%, 91.7%, 94.4%, and 97.2%, respectively. The corresponding accuracies were 85.9%, 89.7%, 93.6%, and 96.2%.
  
  
  CONCLUSIONS
  FDG-PET/CT is the most sensitive, specific, and accurate modality for distant metastasis staging of endemic NPC.
authors.affiliation: Department of Radiation Oncology, National Cancer Centre, Singapore. mel_y2k@yahoo.com
authors.forename: Melvin Lee Kiang
authors.initials: ML
authors.lastname: Chua
authors.forename: Seng Chuan
authors.initials: SC
authors.lastname: Ong
authors.forename: Joseph Tien Seng
authors.initials: JT
authors.lastname: Wee
authors.forename: David Chee Eng
authors.initials: DC
authors.lastname: Ng
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.forename: Terence Wee Kiat
authors.initials: TW
authors.lastname: Tan
authors.forename: Kam Weng
authors.initials: KW
authors.lastname: Fong
authors.forename: Eu Tiong
authors.initials: ET
authors.lastname: Chua
authors.forename: James Boon Kheng
authors.initials: JB
authors.lastname: Khoo
authors.forename: John Seng Hooi
authors.initials: JS
authors.lastname: Low
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D003952:Diagnostic Imaging / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology*; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18