title: Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: the role of US, MRI and FDG-PET/TC scans to assess residual neck disease.
abstract: OBJECTIVE
  To investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).
  
  
  METHODS
  From 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique.
  
  
  RESULTS
  Metastatic disease was assessed in 18/37 (48.6%) hemi-necks, always localized in levels II-IV. US showed greater sensitivity (77.8%) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3%). US, MRI and FDG-PET/TC scans showed the highest specificity (100%), accuracy (93.8%) and positive predictive values (100%).
  
  
  CONCLUSIONS
  In the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Raul
authors.initials: R
authors.lastname: Pellini
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Manciocco
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy. Electronic address: tzmario@inwind.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Turri-Zanoni
authors.affiliation: Department of Radiology, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Vidiri
authors.affiliation: Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.affiliation: Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Marucci
authors.affiliation: Department of Nuclear Medicine, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sciuto
authors.affiliation: Department of Pathology, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Covello
authors.affiliation: Department of Biostatistics, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.affiliation: Department of Radiology, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Ramy
authors.initials: R
authors.lastname: Kayal
authors.affiliation: Department of Radiology, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Anelli
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pichi
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mercante
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spriano
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D037981:Neck Dissection / Q000379:methods*; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000473:pathology; D009959:Oropharyngeal Neoplasms / Q000601:surgery / Q000628:therapy*; D010347:Patient Care Planning; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D018615:Ultrasonography, Doppler, Color / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA
keywords: Chemoradiotherapy; FDG-PET–CT; Neck ultrasound; Oropharyngeal cancer; Planned neck dissection