PET/CT for Head and Neck Squamous Cell Carcinoma: Should We Routinely Include the Head and Abdomen?
OBJECTIVE
The purpose of our study was to determine the diagnostic and therapeutic yield of the head and abdomen portions of PET/CT scans of patients with head and neck squamous cell cancer (HNSCC) to determine whether these areas should be routinely included with PET/CT of the neck and chest.


METHODS
Patients with pathologically proven HNSCC who underwent full-body PET/CT were evaluated for metastases to the head, chest, and abdomen. Medical records were reviewed to determine whether the head and abdominal findings changed the clinical management, beyond the findings in the neck and chest.


RESULTS
Five hundred ninety-eight patients who underwent 1625 PET/CT scans were included. All studies included the head, neck, and chest. For 542 of 598 patients (91%), the PET/CT scans included the abdomen. Two of 598 patients (0.3%) had distant calvarial metastases. Neither of the calvarial metastases changed patient management. Twelve of 542 patients (2.2%) had abdominal metastases. For 10 of 542 patients (1.8%), the abdominal findings changed patient management. Thoracic metastases were found in 82 of 598 patients (13.7%). The total rate of distant metastases to the head and abdomen in patients with thoracic metastatic disease was 12.2% (10/82), whereas in patients without thoracic metastases, it was 0.8% (4/460).


CONCLUSIONS
Routine extension of PET/CT scans to include the head and abdomen in patients with HNSCC is not indicated. For patients without evidence of thoracic metastases, routine PET/CT examinations should include the neck and chest only.
1 Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH.
Uliyana
U
Yankevich
2 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Phoenix, AZ 15213.|3 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Marion A
MA
Hughes
2 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Phoenix, AZ 15213.|3 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Tanya J
TJ
Rath
4 Banner Health and Hospital System, Phoenix, AZ.
Saeed
S
Fakhran
5 Department of Radiology, Barrow Neurological Institute, Phoenix, AZ.
Lea M
LM
Alhilahi
3 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Kim W
KW
Seungwon
2 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Phoenix, AZ 15213.|3 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Barton F
BF
Branstetter
D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000453:epidemiology; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D000072078:Positron Emission Tomography Computed Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012888:Skull Neoplasms / Q000178:diet therapy* / Q000453:epidemiology / Q000556:secondary*; D000077195:Squamous Cell Carcinoma of Head and Neck
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
PET/CT; head and neck cancer; protocol optimization