The impact of multimodality integrated positron emission tomography-computed tomography on improving the staging and management of head and neck malignancy
a cross- sectional study
Keywords:
Head and neck neoplasms, Nasopharyngeal carcinoma, Neoplasm staging, Positron emission tomography computed, tomographyAbstract
BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.
Downloads
References
Kim L, King T, Agulnik M. Head and neck cancer: changing epidemiology and public health implications. Oncology (Williston Park). 2010;24(10):915-9, 924. PMID: 21138172.
Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008;83(4):489-501. PMID: 18380996; https://doi.org/10.4065/83.4.489. Erratum in: Mayo Clin Proc. 2008;83(5):604.
Sanderson RJ, Ironside JA. Squamous cell carcinomas of the head and neck. BMJ. 2002;325(7368):822-7. PMID: 12376446; https://doi.org/10.1136/bmj.325.7368.822.
Agarwal V, Branstetter BF 4th, Johnson JT. Indications for PET/CT in the head and neck. Otolaryngol Clin North Am. 2008;41(1):23-49. PMID: 18261525; https://doi.org/10.1016/j.otc.2007.10.005.
Rohde M, Dyrvig AK, Johansen J, et al. 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography in diagnosis of head and neck squamous cell carcinoma: a systematic review and meta-analysis. Eur J Cancer. 2014;50(13):2271-9. PMID: 25011659; https://doi.org/10.1016/j.ejca.2014.05.015.
Tshering Vogel DW, Thoeny HC. Cross-sectional imaging in cancers of the head and neck: how we review and report. Cancer Imaging. 2016;16(1):20. PMID: 27487932; https://doi.org/10.1186/s40644-016-0075-3.
Park JT, Roh JL, Kim JS, et al. 18F FDG PET/CT versus CT/MR Imaging and the Prognostic Value of Contralateral Neck Metastases in Patients with Head and Neck Squamous Cell Carcinoma. Radiology. 2016;279(2):481-91. PMID: 26653682; https://doi.org/10.1148/radiol.2015250959.
Connell CA, Corry J, Milner AD, Hogg A, 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;29(11):986-95. PMID: 17563906; https://doi.org/10.1002/hed.20629.
El-Khodary M, Tabashy R, Omar W, et al. The role of PET/CT in the management of head and neck squamous cell carcinoma. Egypt J Radiol Nucl Med. 2011;42(2):157-67. https://doi.org/10.1016/j.ejrnm.2011.05.006.
Pisani P, Airoldi M, Allais A, et al. Metastatic disease in head & neck oncology. Acta Otorhinolaryngol Ital. 2020;40(SUPPL.1):S1-S86. PMID: 32469009; https://doi.org/10.14639/0392-100X-suppl.1-40-2020.
Abramyuk A, Appold S, Zöphel K, Baumann M, Abolmaali N. Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy. Strahlenther Onkol. 2013;189(3):197-201. PMID: 23329277; https://doi.org/10.1007/s00066-012-0283-0.
Rohde M, Nielsen AL, Johansen J, et al. Up-front PET/CT changes treatment intent in patients with head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2018;45(4):613-21. PMID: 29124279; https://doi.org/10.1007/s00259-017-3873-3.
Fleming AJ Jr, Smith SP Jr, Paul CM, et al. Impact of [18F]-2-fluorodeoxyglucose–positron emission tomography/computed tomography on previously untreated head and neck cancer patients. Laryngoscope. 2007;117(7):1173-9. PMID: 17603315; https://doi.org/10.1097/MLG.0b013e31805d017b.
Ha PK, Hdeib A, Goldenberg D, 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. PMID: 16415423; https://doi.org/10.1001/archotol.132.1.12.
Scott AM, Gunawardana DH, Bartholomeusz D, Ramshaw JE, Lin P. PET changes management and improves prognostic stratification in patients with head and neck cancer: results of a multicenter prospective study. J Nucl Med. 2008;49(10):1593-600. PMID: 18794254; https://doi.org/10.2967/jnumed.108.053660.
Antoch G, Saoudi N, Kuehl H, et al. Accuracy of whole-body dual-modality fluorine-18–2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22(21):4357-68. PMID: 15514377; https://doi.org/10.1200/JCO.2004.08.120.
Tantiwongkosi B, Yu F, Kanard A, Miller FR. Role of (18)F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma. World J Radiol. 2014;6(5):177-91. PMID: 24876922; https://doi.org/10.4329/wjr.v6.i5.177.
Demirkan A, Kara PO, Oztürk K, et al. The role of 18F-FDG-PET/CT in initial staging and re-staging of head and neck cancer. J Biomed Graph Comput. 2014;4(3):57-66. https://doi.org/10.5430/jbgc.v4n3p57.
Sun R, Tang X, Yang Y, Zhang C. (18)FDG-PET/CT for the detection of regional nodal metastasis in patients with head and neck cancer: a meta-analysis. Oral Oncol. 2015;51(4):314-20. PMID: 25619735; https://doi.org/10.1016/j.oraloncology.2015.01.004.
Senft A, Hoekstra OS, Witte BI, Leemans CR, de Bree R. Screening for distant metastases in head and neck cancer patients using FDG-PET and chest CT: validation of an algorithm. Eur Arch Otorhinolaryngol. 2016;273(9):2643-50. PMID: 26350882; https://doi.org/10.1007/s00405-015-3773-8.
Quon A, Fischbein NJ, McDougall IR, et al. Clinical role of 18F-FDG PET/CT in the management of squamous cell carcinoma of the head and neck and thyroid carcinoma. J Nucl Med. 2007;48 Suppl 1:58S-67S. PMID: 17204721.
Veit-Haibach P, Luczak C, Wanke I, et al. TNM staging with FDG-PET/CT in patients with primary head and neck cancer. Eur J Nucl Med Mol Imaging. 2007;34(12):1953-62. PMID: 17717661; https://doi.org/10.1007/s00259-007-0564-5.
Cacicedo J, Fernandez I, Del Hoyo O, et al. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis. Eur J Nucl Med Mol Imaging. 2015;42(9):1378-89. PMID: 25952280; https://doi.org/10.1007/s00259-015-3071-0.
Lonneux M, Hamoir M, Reychler H, et al. Positron emission tomography with [18F]fluorodeoxyglucose improves staging and patient management in patients with head and neck squamous cell carcinoma: a multicenter prospective study. J Clin Oncol. 2010;28(7):1190-5. PMID: 20124179; https://doi.org/10.1200/JCO.2009.24.6298.
Zanation AM, Sutton DK, Couch ME, et al. Use, accuracy, and implications for patient management of [18F]-2-fluorodeoxyglucose-positron emission/computerized tomography for head and neck tumors. Laryngoscope. 2005;115(7):1186-90. PMID: 15995504; https://doi.org/10.1097/01.MLG.0000163763.89647.9F.
Gordin A, Golz A, Keidar Z, et al. The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care. Otolaryngol Neck Surg. 2007;137(1):130-7. PMID: 17599580; https://doi.org/10.1016/j.otohns.2007.02.001.
Castaldi P, Leccisotti L, Bussu F, Micciche F, Rufini V. Role of (18)F-FDG PET-CT in head and neck squamous cell carcinoma. Acta Otorhinolaryngol Ital. 2013;33(1):1-8. PMID: 23620633.
Plaxton NA, Brandon DC, Corey AS, et al. Characteristics and limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings. AJR Am J Roentgenol. 2015;205(5):W519-31. PMID: 26496574; https://doi.org/10.2214/AJR.14.12828.
Smith AF, Hall PS, Hulme CT, et al. Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer. Eur J Cancer. 2017;85:6-14. PMID: 28881249; https://doi.org/10.1016/j.ejca.2017.07.054.
