title: Positron emission tomography-computed tomography: a superior and one-stop shop modality for treated head and neck carcinoma compared with conventional tomography.
abstract: OBJECTIVE
  The fusion imaging modality of positron-emission tomography-computed tomography (PET-CT) has emerged as an important modality in the management of recurrent head and neck tumors. The aims of this study were to assess the role of PET-CT in the detection of recurrence in treated head and neck squamous cell carcinoma (HNSCC) and compare neck PET-CT and contrast-enhanced computed tomography (CECT) in the detection of locoregional recurrence with histopathologic correlation.
  
  
  METHODS
  The study design was prospective and the study consisted of patients with treated HNSCC referred to the Department of Radiology at Rajiv Gandhi Cancer Institute and Research Center for follow-up or for clinical suspicion of recurrence. PET-CT and CECT neck images were obtained to detect recurrence based on clinical suspicion or as routine follow-up. Comparison of CECT and PET-CT results was performed using receiver operating characteristics (ROC) curves for the detection of locoregional recurrence with histopathologic correlation.
  
  
  RESULTS
  Fifty-eight patients with treated HNSCC underwent neck PET-CT and CECT to detect recurrence based on clinical suspicion or as routine follow-up. The sensitivity and specificity of PET-CT for the detection of locoregional recurrence were 100% and 97.37%, which were considerably higher than 85% and 71.05% when using CECT. The ROC curve and its analysis showed that regional PET-CT is superior to neck CECT in the detection of locoregional recurrence (P = .02). When considering recurrence at the metastatic site, the sensitivity and specificity of PET-CT were 100% and 97.06%. PET-CT also detected second primary tumors in 2 patients.
  
  
  CONCLUSIONS
  PET-CT not only is superior to conventional CECT in the detection of recurrence at locoregional and lymph node sites, but also plays a role in the restaging of recurrent tumors and the detection of distant metastases and second primary tumors. PET-CT, if included in routine post-treatment HNSCC follow-up or in a protocol for suspected recurrence, may have a major impact on the management of patients after treatment of HNSCC.
authors.affiliation: Resident, Department of Radiodiagnosis, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India. Electronic address: kumarvj123@yahoo.com.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Ichpujani
authors.affiliation: Senior Consultant, Department of Radiodiagnosis, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India.
authors.forename: S Avinash
authors.initials: SA
authors.lastname: Rao
authors.affiliation: Professor and Department Head, Department of Radiodiagnosis, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India.
authors.forename: Arvind Kumar
authors.initials: AK
authors.lastname: Chaturvedi
authors.affiliation: Chief, Head and Neck Unit, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Dewan
authors.affiliation: Department Head, Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India.
authors.forename: Partha Sarthi
authors.initials: PS
authors.lastname: Choudhary
mesh_terms: D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D064847:Multimodal Imaging / Q000379:methods*; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed