FDG-PET and detection of distant metastases and simultaneous tumors in head and neck squamous cell carcinoma: A comparison with chest radiography and chest CT

• Published in: Oral oncology 2009-03, Vol.45 (3), p.234-240
• Main Authors: Krabbe, Christiaan A, Pruim, Jan, van der Laan, Bernard F.A.M, Rödiger, L.A, Roodenburg, Jan L.N
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - secondary; Chest CT; Dermatology; FDG-PET; Female; Fluorodeoxyglucose F18; Head and neck cancer; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - pathology; Hematology, Oncology and Palliative Medicine; Humans; Male; Medical sciences; Middle Aged; Neoplasm metastasis; Neoplasms, Second Primary - diagnostic imaging; Otolaryngology; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Positron-Emission Tomography - methods; Radiography, Thoracic - methods; Radiopharmaceuticals; Reproducibility of Results; Second primary neoplasms; Sensitivity and Specificity; Squamous cell carcinoma; Tomography, X-Ray Computed - methods; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Whole Body Imaging
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2008.05.024

Summary Detection of distant metastases and second primary tumors in patients with head and neck squamous cell carcinoma (HNSCC) is of importance because of the impact on treatment and prognosis. The aim of this study was to assess the value of whole-body fluorodeoxyglucose-positron emission tomography (FDG-PET) in detecting distant metastases and second primary tumors below clavicular level in HNSCC compared to chest CT and chest radiography (CXR). Patient records of 149 consecutive patients with a primary HNSCC in whom a whole-body FDG-PET for initial staging was performed were reviewed. FDG-PET showed a sensitivity and specificity for detecting distant disease of 92% and 93%, respectively. Chest CT ( n = 82) showed a sensitivity and a specificity of 74% and 61% respectively. CXR ( n = 106) showed a sensitivity and a specificity of 41% and 91%, respectively. FDG-PET was shown to be able to detect distant metastases and second primary tumors in HNSCC with a high sensitivity and specificity. The higher sensitivity of PET compared to chest CT is mainly due to the detection of extrapulmonary malignancy. Sensitivity of PET and CT were similar in detecting intrapulmonary malignancy, but PET specificity was significantly higher. FDG-PET helps to determine the nature of pulmonary lesions and might be considered as a first diagnostic modality for detecting distant disease in advanced HNSCC.