Vermeersch Hubert, Loose David, Ham Hamphrey, Otte Andreas, Van de Wiele Christophe
Department of Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium.
Eur J Nucl Med Mol Imaging. 2003 Dec;30(12):1689-700. doi: 10.1007/s00259-003-1345-4. Epub 2003 Oct 22.
This article reviews the literature on the use of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) and thallium-201, technetium-99m sestamibi and technetium-99m tetrofosmin single-photon emission tomography (SPET) for the diagnosis and staging of primary and recurrent squamous cell carcinoma of the head and neck (SCCHN). A search of the MEDLINE and CancerLit databases covering articles entered between 1989 and February 2003 was performed. In the case of FDG PET, only full-ring PET studies that included comparison with conventional morphological imaging were considered. Due to the wide variation in methodology, a straightforward meta-analysis of FDG PET literature was impossible. Instead, indicative summary receiver-operating curves of FDG PET and morphological imaging techniques were generated and a paired comparison of the sensitivities and specificities of FDG PET and morphological imaging performed. Compared with conventional morphological imaging, FDG PET proved as sensitive and specific for the detection of primary SCCHN but more sensitive and specific for the detection of cervical lymph node involvement (CLNI) and recurrence of SCCHN. Additional studies addressing the role of FDG PET in screening for distant metastases and synchronous primary tumours are mandatory. Following negative conventional evaluations, FDG PET identifies occult primary tumours in 20-50% of patients presenting with CLNI. As regards the use of 201Tl, 99mTc-sestamibi and 99mTc-tetrofosmin, more studies are required to define whether these imaging agents could form part of the current diagnostic armamentarium in SCCHN patients. It is concluded that FDG PET either is superior to or offers added value when compared with conventional morphological imaging techniques for the purpose of diagnosis and staging of primary and recurrent SCCHN.
本文综述了关于使用氟-18氟脱氧葡萄糖正电子发射断层扫描（FDG PET）以及铊-201、锝-99m甲氧基异丁基异腈和锝-99m四甲基异腈单光子发射断层扫描（SPET）对头颈部原发性和复发性鳞状细胞癌（SCCHN）进行诊断和分期的文献。检索了MEDLINE和CancerLit数据库，涵盖1989年至2003年2月录入的文章。对于FDG PET，仅考虑包含与传统形态学成像比较的全环PET研究。由于方法存在广泛差异，对FDG PET文献进行直接的荟萃分析是不可能的。取而代之的是，生成了FDG PET和形态学成像技术的指示性汇总接受者操作曲线，并对FDG PET和形态学成像的敏感性和特异性进行了配对比较。与传统形态学成像相比，FDG PET在检测原发性SCCHN方面同样敏感和特异，但在检测颈部淋巴结受累（CLNI）和SCCHN复发方面更敏感和特异。必须进行更多研究以探讨FDG PET在筛查远处转移和同步原发性肿瘤中的作用。在传统评估为阴性后，FDG PET可在20%至50%表现为CLNI的患者中识别出隐匿性原发性肿瘤。至于铊-201、锝-99m甲氧基异丁基异腈和锝-99m四甲基异腈的使用，需要更多研究来确定这些成像剂是否可成为目前SCCHN患者诊断手段的一部分。结论是，就原发性和复发性SCCHN的诊断和分期而言，与传统形态学成像技术相比，FDG PET要么更优越，要么具有附加价值。
