TNM staging with FDG-PET/CT in patients with primary head and neck cancer
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PET/CT, PET+CT, and CT were compared concerning accuracies in TNM staging and malignancy detection in head and neck cancer. The impact of PET/CT compared to the other imaging modalities on therapy management was assessed.
Materials and methods
Fifty-five patients with suspected head and neck primary cancer underwent whole-body FDG-PET/CT. PET/CT and PET+CT were evaluated by a nuclear medicine physician and a radiologist; CT was evaluated by two radiologists, PET by two nuclear physicians. Histopathology served as the standard of reference. Differences between the staging modalities were tested for statistical significance by McNemar’s test.
Overall TNM-staging and T-staging with PET/CT were more accurate than PET+CT and CT alone (p < 0.05). PET/CT was marginally more accurate than CT alone in N-staging (p = 0.04); no statistically significant difference was found when compared to PET+CT for N-staging. PET/CT altered further treatment in 13 patients compared to CT only and in 7 patients compared to PET+CT.
Combined PET/CT proved to be partly more accurate in assessing the overall TNM-stage than CT and PET+CT. These results were based on a higher accuracy concerning the T-stage, mainly in patients with metallic implants and marginally the N-stage. Therapy decisions have been influenced in a substantial number of patients. PET/CT might be considered as a first line diagnostic tool in patients with suspected primary head and neck cancer.
KeywordsContrast-enhanced PET/CT TNM staging Head and neck cancer Therapeutic influence
- 2.NCCN. http://www.nccn.org. In: National Comprehensive Cancer Network.
- 6.AWMF. http://www.awmf-online.de.
- 7.ESMO. http://www.esmo.org. In.
- 9.Wong WL, Saunders M. The impact of FDG PET on the management of occult primary head and neck tumours. Clin Oncol (R Coll Radiol) 2003;15(8):461–6.Google Scholar
- 15.Ha PK, Hdeib A, Goldenberg D, Jacene H, Patel P, Koch W, et al. The role of positron emission tomography and computed tomography fusion in the management of early-stage and advanced-stage primary head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2006;132(1):12–6.PubMedCrossRefGoogle Scholar
- 17.Antoch G, Jentzen W, Freudenberg LS, Stattaus J, Mueller SP, Debatin JF, et al. Effect of oral contrast agents on computed tomography-based positron emission tomography attenuation correction in dual-modality positron emission tomography/computed tomography imaging. Invest Radiol 2003;38(12):784–9.PubMedGoogle Scholar
- 24.Valk PE, Bailey DL, Townsend DW, Maisey MN. Positron Emission Tomography: Basic Science and Clinical Practice. London, Berlin, Heidelberg: Springer, 2003.Google Scholar
- 25.AJCC. AJCC Cancer Staging Manual. 6 th. Edition ed. Stuttgart, Heidelberg, New York: Springer; 2002.Google Scholar
- 36.Connell A, Corry J, Milner AD, Hogg A, Hicks RJ, Rischin D, et al. Clinical impact of, and prognostic stratification by, F-18 FDG PET/CT in head and neck mucosal squamous cell carcinoma. Head Neck 2007.Google Scholar
- 37.Wong WL, Hussain K, Chevretton E, Hawkes DJ, Baddeley H, Maisey M, et al. Validation and clinical application of computer-combined computed tomography and positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose head and neck images. Am J Surg 1996;172(6):628–32.PubMedCrossRefGoogle Scholar