Patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (SCC) have a high risk of having distant metastases or second primary tumors. We prospectively evaluate the clinical usefulness of 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET), extended-field multi-detector computed tomography (MDCT), and their side-by-side visual correlation for the detection of distant malignancies in these two tumors at presentation.
Materials and methods
A total of 160 patients with SCC of the oropharynx (n = 74) or hypopharynx (n = 86) underwent 18F-FDG PET and extended-field MDCT to detect distant metastases or second primary tumors. Suspected lesions were investigated by means of biopsy, clinical, or imaging follow-up.
Twenty-six (16.3%) of our 160 patients were found to have distant malignancy. Diagnostic yields of 18F-FDG PET and MDCT were 12.5% and 8.1%, respectively. The sensitivity of 18F-FDG PET for detection of distant malignancies was 1.5-fold higher than that of MDCT (76.9% vs. 50.0%, P = 0.039), while its specificity was slightly lower (94.0% vs. 97.8%, P = 0.125). Side-by-side visual correlation of MDCT and 18F-FDG PET improved the sensitivity and specificity up to 80.8% and 98.5%, respectively, leading to alteration of treatment in 13.1% of patients. A significant difference in survival rates between its positive and negative results was observed.
18F-FDG PET and extended-field MDCT had acceptable diagnostic yields for detection of distant malignancies in untreated oropharyngeal and hypopharyngeal SCC. 18F-FDG PET was 1.5-fold more sensitive than MDCT, but had more false-positive findings. Their visual correlation improved the diagnostic accuracy, treatment planning, and prognosis prediction.
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Kotwall C, Sako K, Razack MS, Rao U, Bakamjian V, Shedd DP (1987) Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg 154:439–442
Mohadjer C, Dietz A, Maier H, Weidauer H (1996) Distant metastasis and incidence of second carcinomas in patients with oropharyngeal and hypopharyngeal carcinomas. HNO 44:134–139
Halpern J (1997) The value of chest CT scan in the work-up of head and neck cancers. J Med 28:191–198
Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V (2001) Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 63:202–207
Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP (2001) Synchronous and metachronous squamous cell carcinomas of the head and neck mucosal sites. J Clin Oncol 19:1358–1362
Loh KS, Brown DH, Baker JT, Gilbert RW, Gullane PJ, Irish JC (2005) A rational approach to pulmonary screening in newly diagnosed head and neck cancer. Head Neck 27:990–994
Reiner B, Siegel E, Sawyer R, Brocato RM, Maroney M, Hooper F (1997) The impact of routine CT of the chest on the diagnosis and management of newly diagnosed squamous cell carcinoma of the head and neck. AJR Am J Roentgenol 169:667–671
Houghton DJ, Hughes ML, Garvey C et al (1998) Role of chest CT scanning in the management of patients presenting with head and neck cancer. Head Neck 20:614–618
Ong TK, Kerawala CJ, Martin IC, Stafford FW (1999) The role of thorax imaging in staging head and neck squamous cell carcinoma. J Craniomaxillofac Surg 27:339–344
Warner GC, Cox GJ (2001) Evaluation of chest radiography versus chest computed tomography in screening for pulmonary malignancy in advanced head and neck cancer. J Otolaryngol 32:107–109
Glynn F, Brennan S, O'Leary G (2006) CT staging and surveillance of the thorax in patients with newly diagnosed and recurrent squamous cell carcinoma of the head and neck: is it necessary? Eur Arch Otorhinolaryngol 263:943–945
Brown DH, Leakos M (1998) The value of a routine bone scan in a metastastic survey. J Otolaryngol 27:187–189
Nilssen EL, Murthy P, McClymont L, Denholm S (1999) Radiological staging of the chest and abdomen in head and neck squamous cell carcinoma—are computed tomography and ultrasound necessary? J Laryngol Otol 113:152–154
Tan L, Greener CC, Seikaly H, Rassekh CH, Calhoun KH (1999) Role of screening chest computed tomography in patients with advanced head and neck cancer. Otolaryngol Head Neck Surg 120:689–692
Jackel MC, Rausch H (1999) Distant metastasis of squamous epithelial carcinomas of the upper aerodigestive tract. The effect of clinical tumor parameters and course of illness. HNO 47:38–44
de Bree R, Deurloo EE, Snow GB, Leemans CR (2000) Screening for distant metastases in patients with head and neck cancer. Laryngoscope 110:397–401
Teknos TN, Rosenthal EL, Lee D, Taylor R, Marn CS (2001) Positron emission tomography in the evaluation of stage III and IV head and neck cancer. Head Neck 23:1056–1060
Wax MK, Myers LL, Gabalski EC, Husain S, Gona JM, Nabi H (2002) Positron emission tomography in the evaluation of synchronous lung lesions in patients with untreated head and neck cancer. Arch Otolaryngol Head Neck Surg 128:703–707
Schwartz DL, Ford EC, Rajendran J et al (2003) Staging of head and neck squamous cell cancer with extended-field FDG-PET. Arch Otolaryngol Head Neck Surg 129:1173–1178
Dresel S, Grammerstorff J, Schwenzer K et al (2003) [18F]FDG imaging of head and neck tumours: comparison of hybrid PET and morphological methods. Eur J Nucl Med Mol Imaging 30:995–1003
Schmid DT, Stoeckli SJ, Bandhauer F et al (2003) Impact of positron emission tomography on the initial staging and therapy in locoregional advanced squamous cell carcinoma of the head and neck. Laryngoscope 113:888–891
Brouwer J, Senft A, de Bree R et al (2006) Screening for distant metastases in patients with head and neck cancer: is there a role for (18F) FDG-PET? Oral Oncol 42:275–280
Keyes JW, Chen MY, Watson NE, Greven KM, McGuirt WF, Williams DW (2000) FDG PET evaluation of head and neck cancer: value of imaging the thorax. Head Neck 22:105–110
Ng SH, Chang JT, Chan SC et al (2004) Nodal metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET. Eur J Nucl Med Mol Imaging 31:1073–1080
Leemans CR, Tiwari R, Nauta JJ, van der Waal I, Snow GB (1993) Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer 71:452–456
Brouwer J, de Bree R, Hoekstra OS et al (2005) Screening for distant metastases in patients with head and neck cancer: is chest computed tomography sufficient? Laryngoscope 115:1813–1817
Brouwer J, de Bree R, Hoekstra OS et al (1994) Synchronous and metachronous head and neck carcinomas. Cancer 74:1933–1938
Calhoun KH, Fulmer P, Weiss R, Hokanson JA (1994) Distant metastases from head and neck squamous cell carcinomas. Laryngoscope 104:1199–1205
Leon X, Quer M, Orus C, del Prado Venegas M, Lopez M (2000) Distant metastases in head and neck cancer patients who achieved loco-regional control. Head Neck 22:680–686
Shaha AR, Hoover EL, Mitrani M, Marti JR, Krespi YP (1998) Synchronicity, multicentricity, and metachronicity of head and neck cancer. Head Neck Surg 10:225–228
Haughey BH, Gates GA, Arfken CL, Harvey J (1992) Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol. Ann Otol Rhinol Laryngol 101:105–112
Jäckel MC, Reischl A, Huppert P (2007) Efficacy of radiologic screening for distant metastases and second primaries in newly diagnosed patients with head and neck cancer. Laryngoscope 117:242–247
Fijuth J, Mazeron JJ, Le Péchoux C et al (1992) Second head and neck cancers following radiation therapy of T1 and T2 cancers of the oral cavity and oropharynx. Int J Radiat Oncol Biol Phys 24:59–64
Parker RG, Enstrom JE (1988) Second primary cancers of the head and neck following treatment of initial primary head and neck cancers. Int J Radiat Oncol Biol Phys 14:561–564
Guardiola E, Pivot X, Dassonville O et al (2004) Is routine triple endoscopy for head and neck carcinoma patients necessary in light of a negative chest computed tomography scan? Cancer 101:2028–2033
Stoeckli SJ, Steinert H, Pfaltz M, Schmid S (2002) Is there a role for positron emission tomography with 18F-fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma. Head Neck 24:345–349
Ng SH, Yen TC, Liao CT et al (2005) 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46:1136–1143
Vansteenkiste JF, Stroobants SG, Dupont PJ et al (1998) FDG PET scan in potentially operable non-small cell lung cancer: do anatometabolic PET–CT fusion images improve the localization of regional lymph node metastases? The Leuven Lung Cancer Group. Eur J Nucl Med Mol Imaging 25:1495–1501
Ng SH, Yen TC, Chang JT et al (2006) Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 24:4371–4376
Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM (2004) Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 231:65–72
Chen YK, Su CT, Ding HJ et al (2006) Clinical usefulness of fused PET/CT compared with PET alone or CT alone in nasopharyngeal carcinoma patients. Anticancer Res 26:1471–1477
Jeong HS, Baek CH, Son YI et al (2007) Use of integrated 18F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma. Head Neck 29:203–210
This work was supported by the National Science Council, grant no. 94-2314-B-182A-109 and by the Chang Gung Memorial Hospital, grant no. 95-0372B.
Conflict of interest statement
We declare that we have no conflict of interest.
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Ng, SH., Chan, SC., Liao, CT. et al. Distant metastases and synchronous second primary tumors in patients with newly diagnosed oropharyngeal and hypopharyngeal carcinomas: evaluation of 18F-FDG PET and extended-field multi-detector row CT. Neuroradiology 50, 969–979 (2008). https://doi.org/10.1007/s00234-008-0426-2