title: Effectiveness of PET/CT in the preoperative evaluation of neck disease.
abstract: OBJECTIVE
  To evaluate the utility of positron emission tomography (PET)/computed tomography (CT) for staging the neck in the preoperative setting by comparing it to both CT/magnetic resonance imaging (MRI) and pathologic staging.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Seventy-one patients with initial diagnosis of head and neck squamous cell carcinoma having preoperative MR or CT imaging and PET/CT with subsequent bilateral neck dissection as part of primary treatment (142 neck dissections). Comparison of cervical nodal metastases based on three separate staging systems: preoperative CT and/or MRI scan, preoperative PET/CT, and pathology.
  
  
  RESULTS
  Both CT/MRI scans and PET/CT scans statistically predicted pathologic outcomes (P = 0.0001, P = 0.0001, respectively) using Chi square analysis. There was a statistically significant improvement in the prediction of true pathologic disease using PET/CT compared to CT and/or MRI alone (P = 0.005). In a subgroup analysis including only the contralateral neck, this significance persisted (P = 0.013). McNemar's test revealed that subsequent detection of bilateral neck disease by PET/CT scan was significantly superior to MRI or CT alone (P = 0.023).
  
  
  CONCLUSIONS
  In pathologically positive necks, PET/CT was statistically more reliable at identifying positive disease than CT or MRI alone. Furthermore, such a result is achieved without a statistically significant difference in false positivity between PET/CT and CT or MRI. This suggests that PET/CT positivity, despite negative clinical exam and CT/MRI findings, may be more likely to signify pathologic disease and require appropriate treatment.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelpha, Pennsylvania, U.S.A.
authors.forename: Anthony
authors.initials: A
authors.lastname: Nguyen
authors.forename: Adam
authors.initials: A
authors.lastname: Luginbuhl
authors.forename: David
authors.initials: D
authors.lastname: Cognetti
authors.forename: Katie
authors.initials: K
authors.lastname: Van Abel
authors.forename: Voichita
authors.initials: V
authors.lastname: Bar-Ad
authors.forename: Charles
authors.initials: C
authors.lastname: Intenzo
authors.forename: William
authors.initials: W
authors.lastname: Keane
authors.forename: Joseph
authors.initials: J
authors.lastname: Curry
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: CT; FDG-PET; MRI; PET/CT; squamous cell carcinoma