Gourin Christine G, Watts Tammara L, Williams Hadyn T, Patel Vijay S, Bilodeau Paul A, Coleman Teresa A
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia, USA.
Laryngoscope. 2008 Apr;118(4):671-5. doi: 10.1097/MLG.0b013e3181625737.
To investigate the utility of positron-emission tomography-computed tomography (PET-CT) in identifying distant metastatic disease in patients with previously untreated head and neck squamous cell cancer (HNSCC) prior to definitive treatment.
Retrospective analysis of 27 consecutive patients with previously untreated HNSCC who underwent PET-CT imaging in addition to chest radiography (CXR) as part of their metastatic workup.
The majority of patients (89%) had TNM stage III or IV disease. PET-CT was suspicious for pulmonary malignancy in four (15%) patients and indeterminate in one (4%) patient. CXR was suspicious for pulmonary malignancy in two (7%) patients. Pulmonary metastases or a new lung primary was present in 3 (11%) patients: 3 of 4 (75%) patients with positive PET-CT scans and 0 of 23 (0%) patients with negative or indeterminate PET-CT scans compared with 2 of 2 (100%) patients with positive CXR and 1 of 25 (4%) patients with negative CXR. The sensitivity and specificity of PET-CT in predicting pulmonary malignancy was 100% and 96%, respectively, with a positive predictive value of 75% and a negative predictive value of 100%. The sensitivity and specificity of CXR in predicting pulmonary malignancy was 67% and 100%, respectively, with a positive predictive value of 100% and a negative predictive value of 96%. Including nonpulmonary sites, the overall incidence of distant metastatic disease was 19% (5/27) with 11% (3/27) unsuspected prior to PET-CT.
PET-CT improves detection of metastatic disease in the high-risk patient and should be performed as part of the routine pretreatment evaluation of patients with advanced stage HNSCC.
探讨正电子发射断层扫描-计算机断层扫描（PET-CT）在明确治疗前未经治疗的头颈部鳞状细胞癌（HNSCC）患者远处转移性疾病中的应用价值。
对27例连续的未经治疗的HNSCC患者进行回顾性分析，这些患者在进行转移灶检查时除了接受胸部X线摄影（CXR）外还接受了PET-CT成像。
大多数患者（89%）为TNM III期或IV期疾病。PET-CT检查中，4例（15%）患者的肺部恶性肿瘤可疑，1例（4%）患者结果不确定。CXR检查中，2例（7%）患者的肺部恶性肿瘤可疑。3例（11%）患者存在肺转移或新发肺原发性肿瘤：PET-CT扫描阳性的4例患者中有3例（75%），PET-CT扫描阴性或结果不确定的23例患者中无1例；相比之下，CXR检查阳性的2例患者中有2例（100%），CXR检查阴性的25例患者中有1例（4%）。PET-CT预测肺部恶性肿瘤的敏感性和特异性分别为100%和96%，阳性预测值为75%，阴性预测值为100%。CXR预测肺部恶性肿瘤的敏感性和特异性分别为67%和100%，阳性预测值为100%，阴性预测值为96%。包括非肺部部位，远处转移性疾病的总体发生率为19%（5/27），其中11%（3/27）在PET-CT检查前未被怀疑。
PET-CT可提高高危患者转移疾病的检测率，应作为晚期HNSCC患者常规预处理评估的一部分进行检查。
