Limitations of FDG-PET and FDG-PET with computed tomography for detecting synchronous cancer in pharyngeal cancer.
OBJECTIVE
To analyze the ability of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and the fusion of FDG-PET with computed tomography (FDG-PET/CT) to detect synchronous upper gastrointestinal tract (UGI) cancer in newly diagnosed pharyngeal squamous cell carcinoma (SCC). Synchronous UGI cancer is a significant problem in treating pharyngeal SCC, particularly for Japanese populations reported to be at high risk. Good results have been reported from the use of FDG-PET and FDG-PET/CT in staging head and neck SCC (HNSCC). An additional advantage is that both techniques are expected to prove useful in detecting synchronous cancer.


METHODS
Retrospective analysis of medical records.


METHODS
Aichi Cancer Center, Nagoya, Japan.


METHODS
Forty-three Japanese patients with pharyngeal SCC were assessed for the ability of FDG-PET and FDG-PET/CT to detect synchronous UGI cancer via a comparison with UGI Lugol chromoendoscopy. The patients had undergone 17 FDG-PET and 26 FDG-PET/CT scans before treatment.


METHODS
Sensitivity of FDG-PET and FDG-PET/CT to detect synchronous UGI cancer.


RESULTS
Pathologically, 6 patients with esophageal SCC (14%) and 4 with stomach adenocarcinoma (9%) were diagnosed on the basis of suspect lesions detected by UGI Lugol chromoendoscopy. One patient was found to have stage T2 esophageal cancer by FDG-PET/CT, but no patients had UGI cancer. The sensitivity of detecting T1 UGI cancer by FDG-PET and FDG-PET/CT was 0%.


CONCLUSIONS
The choice of diagnostic technique must be based on the site and histologic characteristics of the synchronous tumor. Although FDG-PET and FDG-PET/CT are still the preferred techniques for staging HNSCC, neither replaces Lugol chromoendoscopy for detecting synchronous UGI cancer in high-risk populations.
Suzuki
Hidenori
H
Department of Head and Neck Surgery, Aichi Cancer Center, Nagoya, Japan. hasegawa@aichi-cc.jp.
Hasegawa
Yasuhisa
Y
Terada
Akihiro
A
Ogawa
Tetsuya
T
Hyodo
Ikuo
I
Suzuki
Masahiro
M
Nakashima
Tsutomu
T
Tamaki
Tsuneo
T
Nishio
Masami
M
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000473:pathology; D010610:Pharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed
D019788:Fluorodeoxyglucose F18