title: Utility of 18F-FDG PET/CT for detecting neck metastasis in patients with salivary gland carcinomas: preoperative planning for necessity and extent of neck dissection.
abstract: BACKGROUND
  The precise diagnosis of cervical lymph node metastasis (CLNM) of salivary gland cancer is important to determine the surgical extent and adjuvant therapy. This study assessed the clinical utility of (18)F-FDG PET in identifying CLNM in such patients.
  
  
  METHODS
  Fifty-four patients with intermediate or high-grade salivary gland cancer were preoperatively evaluated with (18)F-FDG PET/CT and CT/MRI. Histopathologic analysis of neck dissection tissues was used as the gold standard for assessing imaging techniques. Tumor and nodal maximum standardized uptake values (SUVmax) were measured for each patient. Univariate and multivariate analyses were used to identify CLNM predictive factors.
  
  
  RESULTS
  Of the 54 patients, 24 patients (44%) had CLNM. On a per-patient basis, the sensitivity and specificity of (18)F-FDG PET/CT and CT/MRI were not significantly different (92 vs. 83%, P = 0.625 and 93 vs. 97%, P = 1.000, respectively). On a per-level basis, (18)F-FDG PET/CT was significantly more sensitive and accurate than CT/MRI in the ipsilateral neck (96 vs. 54%, P < 0.001 and 92 vs. 83%, P < 0.001, respectively). The mean nodal SUVmax values of patients with and without nodal metastasis were 4.9 and 2.1, respectively (P = 0.008). Histologic grade was a significant predictor of CLNM (P = 0.014, odds ratio 14.46, 95% confidence interval 1.73-120.79).
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT imaging and histologic grade are useful for detecting CLNM in patients with salivary gland carcinoma. This finding may guide preoperative planning for the necessity and extent of neck dissection in these patients.
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Min-Joo
authors.initials: MJ
authors.lastname: Kim
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Kim
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011379:Prognosis; D019275:Radiopharmaceuticals; D012468:Salivary Gland Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18