Chen Amy Y, Vilaseca Isabel, Hudgins Patricia A, Schuster David, Halkar Ragheev
Department of Otolaryngology, Emory University School of Medicine, Emory Otolaryngology, 1365A Clifton Rd NE, Ste 2315A, Atlanta, GA 30322, USA.
Head Neck. 2006 Jun;28(6):487-95. doi: 10.1002/hed.20362.
The aim of our study was to assess the utility of positron emission tomography (PET) and 2 fluoro-2-deoxy-D-glucose coupled with neck CT compared with contrast-enhanced CT in predicting persistent cancer either at the primary site or cervical lymphatics in patients with oropharyngeal cancer treated with concurrent chemoradiation
Thirty consecutive patients underwent clinical examination, PET-CT, and contrast-enhanced CT to assess response after the completion of the treatment. The outcome variable was positive tissue diagnosis or negative disease at 6 months. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the primary site as well as cervical disease.
Contrast-enhanced CT alone showed the best accuracy in detecting disease at the primary site after treatment (85.7%). Accuracy in evaluating residual tumor in the cervical lymphatics for contrast-enhanced CT and PET-CT was 59.3% and 74.1%, respectively. For evaluating the neck, PET-CT and contrast-enhanced CT demonstrated 100% NPV, but the PPV was 36.3% and 26.6%, respectively.
In this preliminary study, PET-CT seems to be superior to contrast-enhanced CT in predicting persistent disease in the neck after chemoradiation for oropharyngeal or unknown primary cancer, but not at the primary site. However, the possibility of a false-positive result in the neck remains high, and thus overtreatment may result. Even more concerning are the false-negative results. Larger, prospective studies will be important in defining the role of PET-CT in obviating the need for salvage neck dissections after chemoradiation.
我们研究的目的是评估正电子发射断层扫描（PET）和2-氟-2-脱氧-D-葡萄糖联合颈部CT与增强CT相比，在预测接受同步放化疗的口咽癌患者原发部位或颈部淋巴结持续性癌方面的效用。
连续30例患者在完成治疗后接受临床检查、PET-CT和增强CT以评估反应。结局变量为6个月时组织诊断阳性或疾病阴性。计算原发部位以及颈部疾病的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
单独增强CT在检测治疗后原发部位疾病方面显示出最佳准确性（85.7%）。增强CT和PET-CT评估颈部淋巴结残留肿瘤的准确性分别为59.3%和74.1%。对于评估颈部，PET-CT和增强CT的NPV均为100%，但PPV分别为36.3%和26.6%。
在这项初步研究中，PET-CT在预测口咽癌或原发灶不明的癌症同步放化疗后颈部持续性疾病方面似乎优于增强CT，但在原发部位并非如此。然而，颈部假阳性结果的可能性仍然很高，因此可能导致过度治疗。更令人担忧的是假阴性结果。更大规模的前瞻性研究对于确定PET-CT在避免同步放化疗后挽救性颈部清扫术中的作用至关重要。
