title: FDG-PET staging and importance of lymph node SUV in head and neck cancer.
abstract: OBJECTIVE
  The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC.
  
  
  METHODS
  Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on to receive radiotherapy.
  
  
  RESULTS
  The median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p < 0.0007). Maximum SUV for the primary tumor > 8.0 was predictive of worse overall survival (p < 0.045), while the SUV of the lymph nodes was predictive for distant recurrence at one year--with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p < 0.05).
  
  
  CONCLUSIONS
  FDG-PET staging in head and neck cancer has good positive and negative predictive values in determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the first report to find that the SUV of a lymph node is predictive for ECE and also for distant recurrence.
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, PA, USA. greg.kubicek@gmail.com
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kubicek
authors.forename: Collin
authors.initials: C
authors.lastname: Champ
authors.forename: Shannon
authors.initials: S
authors.lastname: Fogh
authors.forename: Fen
authors.initials: F
authors.lastname: Wang
authors.forename: Eashwer
authors.initials: E
authors.lastname: Reddy
authors.forename: Charles
authors.initials: C
authors.lastname: Intenzo
authors.forename: Reginald W
authors.initials: RW
authors.lastname: Dusing
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18