title: 18F-FDG-PET/CT parameters as imaging biomarkers in oral cavity squamous cell carcinoma, is visual analysis of PET and contrast enhanced CT better than the numbers?
abstract: OBJECTIVE
  This study was designed to seek associations between positron emission tomography/computed tomography (PET/CT) parameters, contrast enhanced neck computed tomography (CECT) and pathological findings, and to determine the potential prognostic value of PET/CT and CECT parameters in oral cavity squamous cell carcinoma (OCSCC).
  
  
  METHODS
  36 OCSCC patients underwent staging PET/CT and 30/36 of patients had CECT. PET/CT parameters were measured for the primary tumor and the hottest involved node, including maximum, mean, and peak standardized uptake values (SUV max, SUV mean, and SUV peak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized added metabolic activity (SAM), and normalized standardized added metabolic activity (N SAM). Qualitative assessment of PET/CT and CECT were also performed. Pathological outcomes included: perineural invasion, lymphovascular invasion, nodal extracapsular spread, grade, pathologic T and N stages. Multivariable logistic regression models were fit for each parameter and outcome adjusting for potentially confounding variables. Multivariable Cox proportional hazards models were used for progression free survival (PFS), locoregional recurrence free survival (LRFS), overall survival (OS) and distant metastasis free survival (DMFS).
  
  
  RESULTS
  In multivariable analysis, patients with high (≥ median) tumor SUV max (OR 6.3), SUV mean (OR 6.3), MTV (OR 19.0), TLG (OR 19.0), SAM (OR 11.7) and N SAM (OR 19.0) had high pathological T-stage (T3/T4) (p<0.05). Ring/heterogeneous pattern on CECT qualitative assessment was associated with worse DMFS and OS.
  
  
  CONCLUSIONS
  High PET/CT parameters were associated with pathologically advanced T stage (T3/T4). Qualitative assessment of CECT has prognostic value. PET/CT parameters did not predict clinical outcome.
authors: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: ayse.kendi@emory.edu.
authors: A Tuba
authors: AT
authors: Kendi
authors: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States.
authors: Amanda
authors: A
authors: Corey
authors: Department of Pathology, Emory University, Atlanta, GA, United States.
authors: Kelly R
authors: KR
authors: Magliocca
authors: Biostatistics & Bioinformatics Shared Resource at Winship Cancer Institute of Emory University, Atlanta, GA, United States.
authors: Dana C
authors: DC
authors: Nickleach
authors: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States.
authors: James
authors: J
authors: Galt
authors: Biostatistics & Bioinformatics Shared Resource at Winship Cancer Institute of Emory University, Atlanta, GA, United States.
authors: Jeffrey M
authors: JM
authors: Switchenko
authors: Otolaryngology Head and Neck Surgery, Emory University, Atlanta, GA, United States.
authors: Mark W
authors: MW
authors: El-Deiry
authors: Otolaryngology Head and Neck Surgery, Emory University, Atlanta, GA, United States.
authors: J Trad
authors: JT
authors: Wadsworth
authors: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States.
authors: Patricia A
authors: PA
authors: Hudgins
authors: Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States.
authors: Nabil F
authors: NF
authors: Saba
authors: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States.
authors: David M
authors: DM
authors: Schuster
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016015:Logistic Models; D008297:Male; D009055:Mouth / Q000000981:diagnostic imaging; D009062:Mouth Neoplasms / Q000175:diagnosis*; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D016016:Proportional Hazards Models; D011856:Radiographic Image Enhancement; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Computed tomography; Head and neck carcinoma; Positron emission tomography; Squamous cell carcinoma