Limitations of PET/CT in determining need for neck dissection after primary chemoradiation for advanced head and neck squamous cell carcinoma.
OBJECTIVE
The purpose of our study was to evaluate PET/CT in predicting residual nodal disease after primary chemoradiation (CRT) for head and neck cancer (HNSCC) with N2 disease or greater.


METHODS
A retrospective cohort analysis was conducted. Thirty-eight patients received primary CRT for HNSCC with N2 or greater disease, PET/CT after treatment and neck dissection from January 2003 to December 2006. PET/CT results were correlated with pathology results from neck dissection specimens for each respective side.


RESULTS
Forty-six neck regions were analyzed. Nine were determined to have either PET/CT result reports (n = 5) or pathology reports (n = 4) that were indeterminate. PET/CT demonstrated a sensitivity and specificity of 57.1 and 73.9%, respectively, an accuracy of 67.5%, a positive predictive value of 57.1% and a negative predictive value of 73.9% when compared to the final pathology.


CONCLUSIONS
PET/CT is neither highly sensitive nor highly specific for identifying residual nodal metastases after CRT for advanced-stage HNSCC. Physicians should not rely solely on PET/CT to determine interventions on the neck after CRT. A standardization of language for reporting findings and risk of residual disease is needed.
Department of Nuclear Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA.
Sofia
S
Lyford-Pike
Patrick K
PK
Ha
Heather A
HA
Jacene
John R
JR
Saunders
Ralph P
RP
Tufano
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D010610:Pharyngeal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014062:Tongue Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D014067:Tonsillar Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D016896:Treatment Outcome