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Positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior?

  • Head and Neck Oncology
  • Published:
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Abstract

The capability of modern imaging techniques such as CT, MRI, US and US-guided fine-needle aspiration cytology (USgFNAC) to detect small tumour deposits is limited. Therefore, the detection of occult metastases in the clinically negative neck remains a diagnostic problem. One of the novel options to refine staging of head and neck cancer is [18F]fluorodeoxyglucose positron emission tomography (FDG-PET). To evaluate the diagnostic value of FDG-PET in the detection of occult malignant lymph nodes, we compared the results of FDG-PET with other diagnostic techniques and the histopathological outcome of 15 neck dissection specimens from 15 head and neck cancer patients with a clinically negative neck. Three sides contained metastases of squamous cell carcinoma. FDG-PET enabled detection of metastases in two sides, which were also detected by MRI or USgFNAC. FDG-PET and CT missed metastases in one patient, which were detected by both MRI and USgFNAC. In studies with a detailed examination of lymph nodes of a neck dissection, a low sensitivity of FDG-PET for the detection of occult lymph node metastases is found. It is unlikely that FDG-PET is superior in the detection of occult lymph node metastases in head and neck cancer patients with a palpably negative neck. The histopathological method used seems to be the most important factor for the differences in sensitivity in reported FDG-PET studies. New approaches such as the use of monoclonal antibodies labelled with a positron emitter may improve the results of PET in these patients.

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Authors and Affiliations

  1. Department of Otolaryngology and Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Jolijn Brouwer, Remco de Bree & C. René Leemans

  2. Department of Nuclear Medicine and Clinical PET Center, VU University Medical Center, Amsterdam, The Netherlands

    Emile F. I. Comans & Otto S. Hoekstra

  3. Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands

    Jonas A. Castelijns

Authors
  1. Jolijn Brouwer
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  2. Remco de Bree
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  3. Emile F. I. Comans
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  4. Jonas A. Castelijns
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  5. Otto S. Hoekstra
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  6. C. René Leemans
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Correspondence to Remco de Bree.

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Brouwer, J., de Bree, R., Comans, E.F.I. et al. Positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior?. Eur Arch Otorhinolaryngol 261, 479–483 (2004). https://doi.org/10.1007/s00405-003-0727-3

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  • DOI: https://doi.org/10.1007/s00405-003-0727-3

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