Does (18)FDG PET-CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up?

作者：Abgral R^*; Querellou S; Potard G; Le Roux P Y; Le Duc Pennec A; Marianowski R; Pradier O; Bizais Y; Kraeber Bodere F; Salauen P Y

来源：Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique, 2009, 33(4): 193-200.

DOI：10.1016/j.mednuc.2009.01.010

• Squamous cell carcinoma
• Head and neck cancer
• Positron emission tomography
• F-18-Fluorodeoxyglucose
• Recurrence

Introduction. - Posttreatment follow-up of head and neck squamous cell carcinoma (HNSCC) recurrence is a diagnostic challenge. Tissue distortions from radiation and surgery can obscure early detection of recurrence by conventional follow-up approaches such as physical examination (PE), computed tomography, and magnetic resonance imaging. A number of studies have shown that (18)Fluoro-fluorodeoxyglucose ((18)FDG) Positron emission tomography (PET) may be an effective technique for the detection of persistent, recurrent, and distant metastatic HNSCC after treatment. The aim of this prospective study was to determine the benefits (sensitivity, specificity, predictive values, and accuracy) of (18)FDG PET using hybrid PET-Computed tomography system (PET/CT) in the detection of HNSCC subclinical locoregional recurrence and distant metastases, in patients 12 months after curative treatment with a negative conventional follow up.
Materials and Methods. - Ninety-one patients cured from head and neck squamous cell carcinoma (HNSCC) without any clinical element for recurrence were included. Whole-body (18)FDG PET/CT examination was performed 11.6 +/- 4.4 months after the end of the treatment. The gold standard was histopathology or 6 months imaging follow-up.
Results. - The whole-body (18)FDG PET/CT of the 91 patients in this study consisted of 52 negative and 39 positive results. Nine of these patients who exhibited abnormal (18)FDG uptake in head and neck area did not have subsequently proven recurrent HNSCC (false positive). Thirty had proven recurrence (true positive). All 52 patients with negative readings of (18)FDG PET/CT remained free of disease at 6 months (true negative). The sensitivity and specificity of (18)FDG PET/CT in this study for the diagnosis of HNSCC recurrence were 100% (30/30) and 85% (52/61) respectively. The positive predictive value was 77% (30/39). The negative predictive value was 100% (52/52). The overall accuracy was 90% (82/91).
Conclusion. - The results of our study confirm the high effectiveness of 18FDG PET/CT in assessment of HNSCC recurrence. It suggests that this modality is more accurate than conventional follow-up PE alone in the assessment of patient recurrence after previous curative treatment for HNSCC. Therefore, a PET study could be systematically proposed at 12 months after the end of the treatment.

• 出版日期2009-4