Utility of SUVmaxon18F-FDG PET in detecting cervical nodal metastases.
BACKGROUND
The presence of cervical lymph node metastasis is an important prognostic factor for patients with head and neck squamous cell carcinomas (HNSCC). Accurate assessment of lymph node metastasis in these patients is essential for appropriate prognostic and management purposes. Here, we evaluated the effectiveness of the maximum standardized uptake value (SUVmax) on positron emission tomography (PET) in assessing lymph node metastasis in HNSCC prior to surgery.


METHODS
A retrospective review of 74 patients with HNSCC who underwent PET/CT prior to neck dissection were examined. Pre-operative PET/CT scans were reviewed by two experienced nuclear medicine physicians and SUVmaxof the largest node in each nodal basin documented. These were compared with the histology results of the neck dissection.


RESULTS
A total of 359 nodal basins including 86 basins with metastatic nodes were evaluated. A nodal SUVmax≥3.16 yielded a sensitivity of 74.4 % and specificity of 84.9 % in detecting metastatic nodes. The nodal SUVmax/Liver SUVmaxratio was found on receiver operating characteristic (ROC) to be effective in detecting metastatic nodes with an area under ROC curve of 0.90. A nodal SUVmax/Liver SUVmaxratio ≥0.90 yielded a sensitivity of 74.1 % and specificity of 93.4 %. By comparison, visual inspection yielded sensitivities of 66.3 and 61.6 % in observers 1 and 2 respectively. The corresponding specificities were 77.7 and 86.5 %.


CONCLUSIONS
Nodal SUVmaxand nodal SUVmax/liver SUVmaxare both useful in the pre-operative detection of metastatic nodes with the latter being superior to visual inspection. The ratio is likely to be more useful as it corrects for inter-scanner variability.
Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia. rebecca1188@gmail.com.|Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia. rebecca1188@gmail.com.|Department of Radiology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia. rebecca1188@gmail.com.
Rebecca S M
RS
Lim
Department of Nuclear Medicine & PET, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.
Shakher
S
Ramdave
Department of Nuclear Medicine & PET, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.|Department of Nuclear Medicine, The Alfred, First Floor, East Block, Commercial Road, Melbourne, VIC, 3004, Australia.
Paul
P
Beech
School of Public Health, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
Baki
B
Billah
School of Public Health, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
Md Nazmul
MN
Karim
Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
Julian A
JA
Smith
Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.|Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
Adnan
A
Safdar
Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.|Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
Elizabeth
E
Sigston
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging* / Q000473:pathology; D000072078:Positron Emission Tomography Computed Tomography; D011300:Preoperative Care; D011379:Prognosis; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000077195:Squamous Cell Carcinoma of Head and Neck
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Lymphadenopathy; Metastasis; Positron emission tomography (PET); Squamous cell carcinoma; Standardized uptake value