title: Predictive value of positron emission tomography-computed tomography image fusion in the diagnosis of head and neck cancer: does it really improve staging and management?
abstract: OBJECTIVE
  To determine (1) the accuracy of positron emission tomography - computed tomography in the diagnosis of head and neck cancer, (2) the learning curve involved, and (3) whether its use alters patient management.
  
  
  METHODS
  A retrospective study including 80 patients with head and neck cancer who underwent positron emission tomography - computed tomography image fusion at Blackpool Victoria Hospital.
  
  
  RESULTS
  Fifty-three patients underwent positron emission tomography - computed tomography for staging (32 for detection of a primary tumour and 21 for detection of distant metastasis) and 27 for detection of loco-regional recurrence. Ten primary tumours and 20 recurrences were accurately diagnosed by this method. Eighteen patients had their tumour stage and management modified as a result of this method of imaging. The effect of the learning curve resulted in better true positive detection rates, one year after introduction (81 versus 61 per cent). The sensitivity and specificity of this method in detecting head and neck cancer were 70 and 42 per cent, respectively, whereas those of conventional imaging were 73 and 51 per cent, respectively.
  
  
  CONCLUSIONS
  Compared with magnetic resonance imaging, the benefits of positron emission tomography - computed tomography may be limited to diagnosis of recurrence, as it is less hindered by tissue fibrosis, radiotherapy-related oedema, scarring and inflammation.
authors.affiliation: Department of ENT, Blackpool Victoria Hospital, Manchester, UK. cdecasso@doctors.org.uk
authors.forename: C
authors.initials: C
authors.lastname: de Casso
authors.forename: V
authors.initials: V
authors.lastname: Visvanathan
authors.forename: A
authors.initials: A
authors.lastname: Soni-Jaiswall
authors.forename: T
authors.initials: T
authors.lastname: Kane
authors.forename: A
authors.initials: A
authors.lastname: Nigam
mesh_terms: D001706:Biopsy; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D002983:Clinical Competence; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D006801:Humans; D033162:Incidental Findings; D008207:Lymphatic Metastasis; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging / Q000379:methods; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging*; D015588:Observer Variation; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18