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Comparison between PET and PET/CT in recurrent head and neck cancer and clinical implications

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Abstract

The aim of this retrospective study was to compare the diagnostic accuracy between positron emission tomography (PET) and combined PET/computed tomography (PET/CT) in the detection of recurrent head and neck squamous cell carcinoma (HNSCC) and to evaluate the degree of interobserver agreement. Thirty-two patients who had undergone curative treatment for HNSCC and who presented with a suspicion of recurrent local disease were studied with fluoro-2-deoxy-d-glucose (FDG)-PET imaging. All patients had undergone an inconclusive conventional workup (nasofibroscopy, CT scan and/or MRI). PET and PET/CT were reviewed by two nuclear medicine physicians independently. Performances of PET and PET/CT were compared using biopsy and/or clinical follow-up of at least 8 months as gold-standard. ROC curves were employed for statistical analysis. Out of 32 patients, 18 (56%) had a local recurrence. Intraclass correlation coefficients were strong (>90) and statistically significant (P < 0.0001) for the two reviewers in all cases. The sensitivity, specificity and accuracy of PET were found to be 94%, between 36 and 50% and between 69 and 75%, respectively, depending on the consideration of equivocal cases. Results for PET/CT were found to be 94, 57 and 78%. The utility scores of PET and PET/CT were 0.72 and 0.78, respectively. PET/CT could have a direct impact on patient care with the avoidance of 8/14 (57%) unnecessary invasive procedures (panendoscopy under general anaesthesia). Combined PET/CT is more accurate than PET alone for detection of recurrent HNSCC. The findings of this study are reinforced by the strong interobserver agreement in the interpretation of the results

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Acknowledgment

We would like to thank Dr U McCarthy for helpful discussions

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Authors and Affiliations

  1. Department of Head and Neck Surgery and Federation of Otolaryngology, La Timone University Hospital Center, 264, rue Saint Pierre, 13385, Marseille Cedex 05, France

    Nicolas Fakhry, Antoine Giovanni & Michel Zanaret

  2. Department of Nuclear Medicine, La Timone University Hospital Center, Marseille Cedex 05, France

    David Lussato & Thierry Jacob

  3. Department of Statistics and Medical Information (LERTIM), La Timone University Hospital Center, Marseille Cedex 05, France

    Roch Giorgi

Authors
  1. Nicolas Fakhry
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  2. David Lussato
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  3. Thierry Jacob
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  4. Roch Giorgi
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  5. Antoine Giovanni
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  6. Michel Zanaret
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Correspondence to Nicolas Fakhry.

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Fakhry, N., Lussato, D., Jacob, T. et al. Comparison between PET and PET/CT in recurrent head and neck cancer and clinical implications. Eur Arch Otorhinolaryngol 264, 531–538 (2007). https://doi.org/10.1007/s00405-006-0225-5

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  • DOI: https://doi.org/10.1007/s00405-006-0225-5

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