Journal article
FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma
International journal of radiation oncology, biology, physics, Vol.61(1), pp.129-136
2005
DOI: 10.1016/j.ijrobp.2004.03.040
PMID: 15629603
Abstract
Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck.
Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85%) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings.
FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96% (26 of 27) and 98.5% (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (κ 0.95, 95% confidence interval 0.82–0.99) than for CT alone (κ 0.81, 95% confidence interval 0.63–0.91;
p = 0.06 by two-sided McNemar's testing).
These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.
Details
- Title: Subtitle
- FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma
- Creators
- David L. Schwartz - University of Washington School of MedicineEric Ford - University of Washington School of MedicineJoseph Rajendran - University of Washington School of MedicineBevan Yueh - University of Washington School of MedicineMarc D. Coltrera - University of Washington School of MedicineJeffery Virgin - University of Puget SoundYoshimi Anzai - University of Puget SoundDavid Haynor - University of Washington School of MedicineBarbara Lewellyn - University of Washington School of MedicineDavid Mattes - University of Washington School of MedicineJuergen Meyer - University of Washington School of MedicineMark Phillips - University of Washington School of MedicineMichael Leblanc - University of Washington School of MedicinePaul Kinahan - University of Washington School of MedicineKenneth Krohn - University of Washington School of MedicineJanet Eary - University of Washington School of MedicineGeorge E. Laramore - University of Washington School of Medicine
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.61(1), pp.129-136
- DOI
- 10.1016/j.ijrobp.2004.03.040
- PMID
- 15629603
- NLM abbreviation
- Int J Radiat Oncol Biol Phys
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Publisher
- Elsevier Inc
- Number of pages
- 8
- Language
- English
- Date published
- 2005
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984966745702771
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