Ng Shu-Hang, Yen Tzu-Chen, Chang Joseph Tung-Chieh, Chan Sheng-Chieh, Ko Sheung-Fat, Wang Hung-Ming, Lee Li-Yu, Kang Chung-Jan, Wong Alex Mun-Ching, Liao Chun-Ta
Department of Diagnostic Radiology, Otorhinolaryngology and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan, Republic of China.
J Clin Oncol. 2006 Sep 20;24(27):4371-6. doi: 10.1200/JCO.2006.05.7349.
To assess the clinical usefulness of [(18)F]fluorodeoxyglucose positron emission tomography ([18F]FDG PET) as well as computed tomography (CT) or magnetic resonance imaging (MRI) in oral squamous cell carcinoma (SCC) patients with palpably negative neck.
In total, 134 oral SCC patients with palpably negative neck were prospectively evaluated with [18F]FDG PET, CT/MRI, and their visual correlation. Histopathologic analysis was used as the gold standard for assessment of these imaging techniques.
Thirty-five (26.1%) of our 134 patients were found to have neck metastases. On a level-by-level basis, the sensitivity of [18F]FDG PET for nodal metastases was two-fold higher than that of CT/MRI (41.2% v 21.6%, respectively; P = .021). Visual correlation of [(18)F]FDG PET and CT/MRI yielded slightly higher sensitivity and specificity than [18F]FDG PET alone (47.1% v 41.2%, P = .25; 98.0% v 96.8%, P = .125, respectively). On a patient-by-patient basis, the sensitivity of [18F]FDG PET for neck metastases was 51.4% and increased to 57.1% after visual correlation with CT/MRI. The probabilities of occult neck metastasis after using [(18)F]FDG PET were 6.7% in T1 tumors, 10.8% in T2 tumors, 13.3% in T3 tumors, and 25% in T4 tumors and decreased to 3.3% in T1 tumors and to 9.2% in T2 tumors after visual correlation with CT/MRI.
[(18)F]FDG PET was superior to CT/MRI for detecting palpably occult neck metastasis of oral SCC. Because [(18)F]FDG PET could reduce the probability of occult neck metastasis to less than 15% in T1 to T3 tumors, it should be indicated for evaluation of these subpopulations.
评估[¹⁸F]氟脱氧葡萄糖正电子发射断层扫描（[¹⁸F]FDG PET）以及计算机断层扫描（CT）或磁共振成像（MRI）在颈部触诊阴性的口腔鳞状细胞癌（SCC）患者中的临床应用价值。
总共对134例颈部触诊阴性的口腔SCC患者进行了前瞻性评估，采用[¹⁸F]FDG PET、CT/MRI及其视觉相关性分析。组织病理学分析用作评估这些成像技术的金标准。
在我们的134例患者中，有35例（26.1%）被发现有颈部转移。按级别分析，[¹⁸F]FDG PET对淋巴结转移的敏感性比CT/MRI高两倍（分别为41.2%和21.6%；P = 0.021）。[¹⁸F]FDG PET与CT/MRI的视觉相关性分析产生的敏感性和特异性略高于单独使用[¹⁸F]FDG PET（分别为47.1%和41.2%，P = 0.25；98.0%和96.8%，P = 0.125）。按患者个体分析，[¹⁸F]FDG PET对颈部转移的敏感性为51.4%，与CT/MRI进行视觉相关性分析后增至57.1%。使用[¹⁸F]FDG PET后，T1肿瘤隐匿性颈部转移的概率为6.7%，T2肿瘤为10.8%，T3肿瘤为13.3%，T4肿瘤为25%，与CT/MRI进行视觉相关性分析后，T1肿瘤降至3.3%，T2肿瘤降至9.2%。
[¹⁸F]FDG PET在检测口腔SCC颈部触诊隐匿性转移方面优于CT/MRI。由于[¹⁸F]FDG PET可将T1至T3肿瘤隐匿性颈部转移的概率降低至15%以下，因此应将其用于评估这些亚组患者。
