Screening for distant metastases in head and neck cancer patients using FDG-PET and chest CT: validation of an algorithm.
In patients with head and neck squamous cell carcinoma and high-risk factors, the combination of whole body FDG-PET and contrast-enhanced chest CT has the highest sensitivity and accuracy when screening for distant metastases. The aim of the present study was to retrospectively validate an earlier developed algorithm for interpreting the combination of screening PET and CT. The test cohort consisted of 47 consecutive HNSCC patients with high-risk factors for distant metastases, who had previously undergone FDG-PET and CT and had a minimum 12 months of follow-up. In 12 (26 %) patients, distant metastases were detected during screening or within 12-month follow-up. In patients with locoregional control during follow-up, the sensitivity and specificity were 55 % (95 % CI 23-83 %) and 97 % (95 % CI 82-99 %), respectively, for chest CT, 55 % (95 % CI 23-83 %) and 100 % (95 % CI 88-100 %), respectively, for PET and 73 % (95 % CI 39-94 %) and 100 % (95 % CI 88-100 %), respectively, for the combination of PET and CT. The proposed algorithm was considered to have been validated. In this algorithm, all FDG-PET positive scans for distant metastases (regardless of interpretation of a solid lung lesion on CT) and CT scans with suspicious pulmonary lesions of less than 5-mm diameter (regardless of FDG-PET findings) are considered positive for distant metastases.
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Asaf
A
Senft
Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Otto S
OS
Hoekstra
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
Birgit I
BI
Witte
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
C René
CR
Leemans
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. R.deBree@umcutrecht.nl.|Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. R.deBree@umcutrecht.nl.
Remco
R
de Bree
D000328:Adult; D000368:Aged; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
18F-fluorodeoxyglucose; Algorithm; Computerized tomography; Distant metastases; Head and neck squamous cell carcinoma; Positron emission tomography; Screening