Brkovich Victoria S, Miller Frank R, Karnad Anand B, Hussey David H, McGuff H Stan, Otto Randal A
Department of Otolaryngology-HNS, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
Laryngoscope. 2006 Jun;116(6):855-8. doi: 10.1097/01.mlg.0000214668.98592.d6.
The objective of this study was to determine the sensitivity, specificity, and predictive value of 18-fluorodeoxyglucose positron emission tomography (PET) in predicting residual cervical metastatic disease in patients with N-positive necks undergoing curative radiotherapy and chemoradiotherapy for squamous cell carcinoma (SCC) of the upper aerodigestive tract.
The authors studied a prospective case series of patients (2003-2005) of patients undergoing radiotherapy and chemoradiotherapy for advanced head and neck SSC. Study entry criteria included N-positive neck disease, a complete response to treatment at the primary tumor site, posttreatment PET scan (8-12 weeks after completion of treatment), followed by salvage neck dissection. The posttreatment PET scan neck findings were correlated to the salvage neck dissection pathology report. The sensitivity, specificity, and predictive values of the PET scan to predict residual cervical metastatic disease after curative chemoradiotherapy were calculated.
Twenty-one neck dissections (pretreatment N1 = 5, N2a = 2, N2b = 8, N3 = 6) were entered into the protocol. Four (19.0%) of the 21 neck specimens were positive for residual cervical metastatic disease, whereas the remaining 17 (80.9%) specimens demonstrated no residual carcinoma. The overall sensitivity and specificity were 75.0% and 64.7%, respectively. The positive predictive value was 33% and the negative predictive value was 91.7%.
Although the role of posttreatment neck dissection remains controversial, the surgeon must rely on clinical examination and imaging studies. Our practice has been to perform planned staged neck dissections on all N2 and N3 necks, as well as N1 necks with an incomplete response to treatment. Based on this small prospective study, it appears that PET imaging lacks adequate sensitivity and specificity to reliably predict the presence of residual cervical metastatic disease after completion of chemoradiotherapy. With a negative predictive value of 91.7%, however, a negative PET scan appears to be a reliable predictor of the absence of residual tumor.
本研究的目的是确定18-氟脱氧葡萄糖正电子发射断层扫描（PET）在预测接受根治性放疗和化疗的上消化道鳞状细胞癌（SCC）颈部N阳性患者残留颈部转移性疾病方面的敏感性、特异性和预测价值。
作者研究了一组前瞻性病例系列（2003 - 2005年）接受晚期头颈部鳞状细胞癌放疗和化疗的患者。研究纳入标准包括颈部N阳性疾病、原发肿瘤部位对治疗的完全缓解、治疗后PET扫描（治疗完成后8 - 12周），随后进行挽救性颈清扫术。将治疗后PET扫描的颈部检查结果与挽救性颈清扫术的病理报告进行对比。计算PET扫描预测根治性放化疗后残留颈部转移性疾病的敏感性、特异性和预测价值。
21例颈清扫术（治疗前N1 = 5，N2a = 2，N2b = 8，N3 = 6）纳入该方案。21例颈部标本中有4例（19.0%）残留颈部转移性疾病呈阳性，而其余17例（80.9%）标本未显示残留癌。总体敏感性和特异性分别为75.0%和64.7%。阳性预测值为33%，阴性预测值为91.7%。
尽管治疗后颈清扫术的作用仍存在争议，但外科医生必须依靠临床检查和影像学研究。我们的做法是对所有N2和N3颈部以及对治疗反应不完全的N1颈部进行计划性分期颈清扫术。基于这项小型前瞻性研究，PET成像似乎缺乏足够的敏感性和特异性来可靠地预测放化疗完成后残留颈部转移性疾病的存在。然而，阴性预测值为91.7%，PET扫描阴性似乎是无残留肿瘤的可靠预测指标。
