title: Screening for distant metastases before salvage surgery in patients with recurrent head and neck squamous cell carcinoma: a retrospective case series comparing thoraco-abdominal CT, positron emission tomography and abdominal ultrasound.
abstract: OBJECTIVE
  To evaluate the role of 18-fluoro-deoxy-d-glucose (FDG)-positron emission tomography (PET) scan for detecting distant metastases in the preoperative assessment of patients with recurrent head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University Teaching Hospital.
  
  
  METHODS
  Thirty-seven consecutive patients who presented, between April 2008 and April 2010, a local and/or regional recurrence of head and neck squamous cell carcinoma after treatment with radio-chemotherapy were studied. The work-up included thoraco-abdominal computed tomography (CT), fluoro-deoxy-D-glucose-positron emission tomography scan and abdominal ultrasound. The imaging results, when positive, were compared to histology or cytology (conducted during targeted examinations, for example, fiberoptic oesophago-gastro-duodenal search, colonoscopy, bronchoscopy, liver biopsy) or targeted imaging examination (Abdominal MRI, sonography) combined with clinical follow-up. All patients were followed-up for at least 6 months. Positron emission tomography performances were then analysed and compared with those of conventional imaging for detecting distant metastases.
  
  
  RESULTS
  Among the 37 patients, 9 (24%) had visceral metastases. The sensitivity, specificity, positive predictive value and negative predictive value for detecting metastasis or second primary were, respectively, 100%, 94%, 86% and 100% for CT and 92%, 87%, 74% and 97% for positron emission tomography. Computed tomography and positron emission tomography were strictly concordant in 32/37 (86%) of cases. No false-negative result was found for CT, while we found one case of false-negative positron emission tomography. The number of false-positive results was two for CT and four for positron emission tomography.
  
  
  CONCLUSIONS
  From our study, positron emission tomography does not appear to offer a first-choice technique for the detection of metastases before salvage surgery as CT detected all lesions visible on positron emission tomography.
authors.affiliation: Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Marseille.
authors.forename: N
authors.initials: N
authors.lastname: Fakhry
authors.forename: J
authors.initials: J
authors.lastname: Michel
authors.forename: C
authors.initials: C
authors.lastname: Colavolpe
authors.forename: A
authors.initials: A
authors.lastname: Varoquaux
authors.forename: P
authors.initials: P
authors.lastname: Dessi
authors.forename: A
authors.initials: A
authors.lastname: Giovanni
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D004724:Endoscopy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18