title: Evaluation of positron emission tomography imaging to detect lymph node metastases in patients with high-risk cutaneous squamous cell carcinoma.
abstract: Ten to twenty percent of high-risk cutaneous squamous cell carcinoma (cSCC) can metastasize to regional lymph nodes. Detection of nodal metastasis is mandatory to manage high-risk cSCC. This study was aimed to evaluate the18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to assess lymph node (LN) metastasis of high-risk cSCC patients. Twenty-six patients with histologically proven primary cSCC were enrolled. All patients underwent whole-body PET prior to lymphoscintigraphy and subsequent sentinel LN biopsy. The maximum standardized uptake value (SUVmax) of more than 2.5 is generally evaluated as a positive PET finding indicative of malignancy. On the basis of the histopathological and PET findings, 30 LN from 26 patients were categorized into four groups: (i) histologically negative and PET negative (true-negative; n = 22); (ii) histologically positive and PET negative (false-negative; n = 0); (iii) histologically positive and PET positive (true-positive; n = 3); and (iv) histologically negative and PET positive (false-positive; n = 5). The mean SUVmax was significantly higher in the true-positive cases (11.0 ± 2.8) than in the false-positive cases (3.4 ± 0.6). In the false-positive cases, the number of tumor-infiltrating inflammatory cells at the primary skin site was highest among the four groups, suggesting that inflammation contributed to the false-positive uptake of FDG. Although we cannot negate the possibility of the presence of PET-undetectable micrometastasis, the SUVmax value may be useful for avoidance of excess performance of sentinel LN biopsy.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. masaofuj@mth.biglobe.ne.jp.
authors.forename: Masao
authors.initials: M
authors.lastname: Fujiwara
authors.affiliation: Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Takiguchi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Fukamizu
authors.affiliation: Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tokura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012878:Skin Neoplasms / Q000000981:diagnostic imaging*
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: computed tomography; lymph node; metastasis; positron emission tomography; squamous cell carcinoma