Ong Seng Chuan, Schöder Heiko, Lee Nancy Y, Patel Snehal G, Carlson Diane, Fury Matthew, Pfister David G, Shah Jatin P, Larson Steven M, Kraus Dennis H
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Nucl Med. 2008 Apr;49(4):532-40. doi: 10.2967/jnumed.107.044792. Epub 2008 Mar 14.
For patients with locoregional advanced head and neck squamous cell carcinoma (HNSCC), concurrent chemoradiotherapy is a widely accepted treatment, but the need for subsequent neck dissection remains controversial. We investigated the clinical utility of 18F-FDG PET/CT in this setting.
In this Institutional Review Board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant retrospective study, we reviewed the records of patients with HNSCC who were treated by concurrent chemoradiation therapy between March 2002 and December 2004. Patients with lymph node metastases who underwent 18F-FDG PET/CT > or = 8 wk after the end of therapy were included. 18F-FDG PET/CT findings were validated by biopsy, histopathology of neck dissection specimens (n = 18), or clinical and imaging follow-up (median, 37 mo).
Sixty-five patients with a total of 84 heminecks could be evaluated. 18F-FDG PET/CT (visual analysis) detected residual nodal disease with a sensitivity of 71%, a specificity of 89%, a positive predictive value (PPV) of 38%, a negative predictive value (NPV) of 97%, and an accuracy of 88%. Twenty-nine heminecks contained residual enlarged lymph nodes (diameter, > or =1.0 cm), but viable tumor was found in only 5 of them. 18F-FDG PET/CT was true-positive in 4 and false-positive in 6 heminecks, but the NPV was high at 94%. Fifty-five heminecks contained no residual enlarged nodes, and PET/CT was true-negative in 50 of these, yielding a specificity of 96% and an NPV of 98%. Lack of residual lymphadenopathy on CT had an NPV of 96%. Finally, normal 18F-FDG PET/CT excluded residual disease at the primary site with a specificity of 95%, an NPV of 97%, and an accuracy of 92%.
In patients with HNSCC, normal 18F-FDG PET/CT after chemoradiotherapy has a high NPV and specificity for excluding residual locoregional disease. In patients without residual lymphadenopathy, neck dissection may be withheld safely. In patients with residual lymphadenopathy, a lack of abnormal 18F-FDG uptake in these nodes also excludes viable tumor with high certainty, but confirmation of these data in a prospective study may be necessary before negative 18F-FDG PET/CT may become the only, or at least most-decisive, criterion in the management of the neck after chemoradiotherapy.
对于局部区域晚期头颈部鳞状细胞癌（HNSCC）患者，同步放化疗是一种广泛接受的治疗方法，但后续是否需要行颈部淋巴结清扫仍存在争议。我们研究了18F-FDG PET/CT在此情况下的临床应用价值。
在这项经机构审查委员会（IRB）批准且符合健康保险流通与责任法案（HIPPA）的回顾性研究中，我们回顾了2002年3月至2004年12月期间接受同步放化疗的HNSCC患者的记录。纳入治疗结束后≥8周接受18F-FDG PET/CT检查的有淋巴结转移的患者。18F-FDG PET/CT检查结果通过活检、颈部淋巴结清扫标本的组织病理学检查（n = 18）或临床及影像学随访（中位时间为37个月）进行验证。
65例患者共84侧半颈部可进行评估。18F-FDG PET/CT（视觉分析）检测残留淋巴结疾病的灵敏度为71%，特异度为89%，阳性预测值（PPV）为38%，阴性预测值（NPV）为97%，准确率为88%。29侧半颈部有残留肿大淋巴结（直径≥1.0 cm），但其中仅5侧发现有存活肿瘤。18F-FDG PET/CT在4侧半颈部为真阳性，6侧半颈部为假阳性，但其NPV较高，为94%。55侧半颈部无残留肿大淋巴结，其中50侧PET/CT为真阴性，特异度为96%，NPV为98%。CT显示无残留淋巴结肿大的NPV为96%。最后，18F-FDG PET/CT结果正常排除了原发部位残留疾病，特异度为95%，NPV为97%，准确率为92%。
对于HNSCC患者，放化疗后18F-FDG PET/CT结果正常对于排除局部区域残留疾病具有较高的NPV和特异度。对于无残留淋巴结肿大的患者，可以安全地不行颈部淋巴结清扫。对于有残留淋巴结肿大的患者，这些淋巴结缺乏异常18F-FDG摄取也高度确定地排除了存活肿瘤，但在18F-FDG PET/CT阴性结果成为放化疗后颈部处理的唯一或至少是最具决定性的标准之前，可能需要在前瞻性研究中对这些数据进行确认。
