title: The value of follow-up FDG-PET/CT in the management and prognosis of patients with HPV-positive oropharyngeal squamous cell carcinoma.
abstract: BACKGROUND
  To establish the accuracy of follow-up fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and the impact of FDG PET/CT result on management decisions and patient outcome prediction (overall and progression free survival) in human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC).
  
  
  METHODS
  We included 96 HPV-positive oropharyngeal SCC (OPSCC) patients with 254 follow-up PET/CT scans in the study. The PET/CT result accuracy was established with histopathology or 6-month clinical follow-up as reference standard. The impact on change in management was established for each follow-up PET/CT scan. Overall survival was evaluated using Kaplan-Meier plots with a Log-rank test.
  
  
  RESULTS
  The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the follow-up FDG-PET/CT were 97.0%, 92.5%, 67.0%, 99.5% and 93.1%, respectively. Follow-up PET/CT results were helpful in excluding tumour in 22% (9/41) of scans performed with prior clinical suspicion of disease and identified potential disease in 9.9% (21/213) scans performed without prior clinical suspicion. There was a change in management after 12.6% (32/254) scans. In 84.3% (214/254) scans, the patients were either observed or the same treatment was continued. The overall survival differed significantly between patients with a negative versus positive follow-up scan (log rank P < 0.001). The median progression free survival was 28 months, if the first follow-up scan performed within 6-12 months post-treatment completion was negative.
  
  
  CONCLUSIONS
  Follow-up FDG PET/CT scans have an impact on the management plan and add value to clinical assessment in patients with HPV-positive OPSCC.
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Taghipour
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Marcus
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Califano
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Carole
authors.initials: C
authors.lastname: Fakhry
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Rathan M
authors.initials: RM
authors.lastname: Subramaniam
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality*; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000401:mortality*; D000072078:Positron Emission Tomography Computed Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: HPV; PET/CT; accuracy; follow-up; oropharyngeal SCC; survival