Positron Emission Tomography in ORL Oncology
Authors:
H. Binková 1; Z. Horáková 1
; J. Staníček 2
Authors‘ workplace:
Klinika otorinolaryngologie a chirurgie hlavy a krku LF MU a FN u sv. Anny, Brno, přednosta prof. MUDr. R. Kostřica, CSc.
1; Odd. nukleární medicíny a pozitronové emisní tomografie, Masarykův onkologický ústav, Brno, primář MUDr. K. Bolák
2
Published in:
Otorinolaryngol Foniatr, 60, 2011, No. 3, pp. 132-138.
Category:
Original Article
Overview
Positron emission tomography is a modern diagnostic method based on monitoring of intravenously applied glucose distribution marked with radionuclide F18.
Increased glucose consumption of malign cells enables their detection, which is unfortunately not exclusively specific for tumor tissues but generally mirrors an increased metabolic cell activity. Better anatomic resolution is provided by PET/CT fusion.
Aims:
We have summarised our 10 year experience with PET diagnostics in patients treated in ENT clinic of St. Anne’s university hospital in Brno. From 2000 to 2009 in 67 oncologic patients 97 PET scanning were undertaken.
Results:
67 of all 97 PET studies were positive, while CT scans were positive in 63 patients. Both studies were in accordance in 77 patients (55 both positive, 22 both negative), which makes 79%. In patients with any discrepancy were radiodiagnostic results compared with histopathology. The estimated CT sensitivity was 89% and specificity 87%, PET sensitivity 91% and specificity 87%. Further we analyzed PET benefit for diagnostics of lymph node metastases persistence after CHRT in organ preserving protocol. In 17 patients CT and PET results were histopathologically confirmed after neck dissection. Sensitivity in this indication was 45% in contrast to high specificity 96%, negative predictive value was 78%.
Conclusion:
PET and CT sensitivity and specificity are mutually comparable and relatively high. Group of patients in our study is non - homogeneous in respect to tumor locality and PET indication. Low sensitivity and negative predictive value for persistent lymph node metastases wouldn’t justify regarding PET as a tool suitable for elimination of neck dissection. All above mentioned facts and its high financial demands are our reasons for the selective and nonstandard PET indication in the oncological patients.
Key words:
PET, CT, head, neck, cancer, specificity, sensitivity.
Sources
1. Adams, S., Baum, R., Stuckensen, T. et al.: Prospective comparison of 18- FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur. J. Nucl. Med., 25, 1998, s. 1255-1260.
2. Brix, G., Lechel, U., Glatting, G., Ziegler, S. I., Münzing, W., Müller, S. P., Beyer T.: Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations. J. Nucl. Med., 46, 2005, 4, s. 608-613.
3. Bronstein, A. D., Nyberg, D. A., Schwarz, A. N., Shuman, W.P., Griffin, B. R.: Soft-tissue changes after head and neck radiation: CT findings. American Journal of Neuroradiology, 10, 1989, 1, s. 171-175.
4. Conessa, C., Hervé, S., Foehrenbach, H., Poncet, J. L.: FDG-PET scan in local follow-up of irradiated head and neck squamous cell carcinomas. Annals of Otology, Rhinology and Laryngology, 113, 2004, 8, s. 628-635.
5. Delbeke, D., Martin, W. H.: Positron emission tomography imaging in oncology. Radiologic Clinics of North America, 39, 2001, 5, s. 883-917.
6. Eschmann, S. M., Paulsen, F., Bedeshem, C. et al.: Hypoxia-imaging with (18) F-Misonidazole and PET: changes of kinetics during radiotherapy of head and neck cancer. Radiother. Oncol., 83, 2007, 3, s. 406-410.
7. Fogarty, G. B., Peters, L. J., Stewart, J., Scott, C., Rischin, D. , Hicks, R. J.: The usefulness of fluorine 18-labelled deoxyglucose positron emission tomography in the investigation of patients with cervical lymphadenopathy from an unknown primary tumor. Head and Neck, 25, 2003, 2, s. 138-145.
8. Gordin, A., Golz, A., Keidar, Z., Daitzchman, M., Bar-Shalom, R., Izrael, O.: The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care. Otolaryngology, 137, 2007, 1, s. 130-137.
9. Greven, K. M., Keyes, J. W. Jr, Williams, D. W.3rd, McGuirt, W. F., Joyce, W.T. 3rd: Occult primary tumors of the head and neck: lack of benefit from positron emission tomography imaging with 2-[F-18]fluoro-2-deoxy-D-glucose. Cancer, 86, 1999, 1, s. 114-118.
10. Greven, K. M., Williams, D. W. III, McGuirt, W. F. Sr. et al.: Serial positron emission tomography scans following radiation therapy of patients with head and neck cancer. Head and Neck, 23, 2001, 11, s. 942-946.
11. Ha, P. K., Hdeib, A., Goldenberg, D. et al.: The role of positron emission tomography and computed tomography vision in the management of early stage and advanced stage primary head and neck squamous cell carcinona. Arch. Otolaryngol. And Neck Surg., 132, 2006, s. 12-16.
12. Heron, D., Andrade, R., Flickinger, J. et al.: Hybrid PET-CT simulation for radiation treatment planning in head and neck cancers: a brief technical report. Int. J. Radiat. Oncol. Biol. Phys., 60, 2004, s. 1419-1424.
13. Horáková, Z., Rothová, E.: Význam PET pro diagnostiku perzistence krčních metastáz po léčbě v ámci záchovného protokolu u pokročilých karcinomů hlavy a krku. Otorinolaryng. a Foniat. /Prague/, 57, 2008, č. 4, s. 213-217.
14. Chua, M. L., Ong, S. C., Wee, J. T. et al.: Comparison of 4 modalities for distant metastasis staging in endemic nasopharyngeal carcinoma. Head and Neck, 31, 2009, 3, s. 346-354.
15. Keller, F., Psychogios, G., Linke, R., Lell, M., Kuwert, T., Iro, H., Zenk, J.: Carcinoma of unknown primary in the head and neck: Comparison between positron emission tomography (PET) and PET/CT. Head Neck, 2010, Dec 15, [Epub ahead of print].
16. Kim, S. Y., Lee, S. W., Nam, S. W. et al.: The feasibility of 18F-FDG PET scans 1 month after completing radiotherapy of squamous cell carcinoma of the head and neck. Journal of Nuclear Medicíně, 48, 2007, 3, s. 373-378.
17. Kolářová, I., Vaňásek, J., Odrážka, K., Petrželka, L., Doležel, M., Nechvíl, J.: Využití PET/CT vyšetření při plánování radioterapie nádorů ORL oblasti. Klinická onkologie, 22, 2009, 3, s. 98-103.
18. Kostakoglu, L., Goldsmith, S. J.: PET in the assessment of therapy response in patients with carcinoma of the head and neck and of the esophagus. Journal of Nuclear Medicíne, 45, 2004, 1, s.56-68.
19. Kovács, A. F., Döbert, N., Gaa, J., Menzel ,C., Bitter, K.: Positron emission tomography in combination with sentinel node biopsy reduces the rate of elective neck dissections in the treatment of oral and oropharyngeal cancer. J. Clin. Oncol., 22, 2004, 19, s. 3973-3980.
20. Martin, R. C., Fulham, M., Shannon, K. F. et al.: Accuracy of positron emission tomography in the evaluation of patients treated with chemoradiotherapy for mucosal head and neck cancer. Head and Neck, 31, 2009, 2, s. 244-250.
21. Mendenhall, W. M., Mancuso, A. A., Amdur, A. A., Stringer, S. P.,Villaret, D. B., Cassisi, N. J.: Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site. American Journal of Otolaryngology, 22, 2001, 4, s. 261-267.
22. Nahmias, C., Carlson, E. R., Duncan, L.D., Blodgett, T. M., Kennedy, J., Long, M. J., Carr, C., Hubner, K. F., Townsend, D. W.: Positron emission tomography/computerized tomography (PET/CT) scanning for preoperative staging of patients with oral/head and neck cancer. J. Oral. Maxillofac. Surg., 65, 2007, 12, s. 2524-2535. Ann. Otol. Rhinol. Laryngol., 117, 2008, 11, s. 854-863.
23. Richard, C., Prevot, N., Timoshenko, A. P., Dumollard, J. M., Dubios, F., Martin, C., Prades, J. M.: Preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography imaging in head and neck cancer: does it really improve initial N staging? Acta Otolaryngol., 130, 2010, 12, s. 1421-1424. Epub 2010 Aug 25.
24. Rogers, J. W., Greven, K. M., McGuirt, W. F. et al.: Can post-rt neck dissection be omitted for patients with head-and-neck cancer who have a negative pet scan after definitive radiation therapy? International Journal of Radiation Oncology Biology Physics., 58, 2004, 3, s. 694-697.
25. Rusthoven, K. E., Koshy, M., Paulino, A. C.: The role of PET-CT fusion in head and neck cancer. Oncology (Williston Park), 19, 2005, 2, s. 241-246; discussion 246, 249-50, 253.
26. Schroeder, U., Dietlein, M., Wittekindt, C., Ortmann, M., Stuetzer, H., Vent, J., Jungehuelsing, M., Krug, B.: Is there a need for positron emission tomography imaging to stage the N0 neck in T1-T2 squamous cell carcinoma of the oral cavity or oropharynx? Ann. Otol. Rhinol. Laryngol., 117, 2008, 11, s. 854-863.
27. Silva, P., Hulse, P., Sykes, A. J. et al.: Should FDG-PET scanning be routinely used for patients with an unknown head and neck squamous primary?Journal of Laryngology and Otology, 121, 2007, 2, s. 149-153.
28. Wenzel, S., Sagowski, C., Kehrl, W., Metternich, F.U.: The prognostic impact of metastatic pattern of lymph nodes in patients with oral and oropharyngeal squamous cell carcinomas. European Archives of Oto-Rhino-Laryngology, 261, 2004, 5, s. 270-275.
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