Yamazaki Yutaka, Saitoh Masaaki, Notani Ken-ichi, Tei Kanchu, Totsuka Yasunori, Takinami Shu-ichi, Kanegae Kakuko, Inubushi Masayuki, Tamaki Nagara, Kitagawa Yoshimasa
Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Kita-13, Nishi-7, Kita-ku, Sapporo, Japan.
Ann Nucl Med. 2008 Apr;22(3):177-84. doi: 10.1007/s12149-007-0097-9. Epub 2008 May 23.
To evaluate the diagnostic accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) relative to computed tomography (CT) for detecting metastatic cervical lymph nodes in patients with squamous cell carcinoma of the head and neck (HNSCC), and to ascertain the factors that affect this accuracy.
A total of 1076 lymph nodes obtained from 35 neck dissections in 26 HNSCC patients who preoperatively underwent both FDG-PET and CT were retrospectively analyzed. For pathological metastatic lymph nodes, the lymph node size (short-axis diameter), the ratio of intranodal tumor deposits, and the size of intranodal tumor deposits (maximum diameter of metastatic foci in each lymph node) were histologically recorded.
Forty-six lymph nodes from 23 neck sides were pathologically diagnosed metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET evaluated individually per neck side were 74%, 92%, 80%, 94%, and 65%, respectively, whereas those of CT were 78%, 58%, 71%, 78%, and 58%, respectively. FDG-PET detected 100% of metastatic lymph nodes > or =10 mm, intranodal tumor deposits > or =9 mm, and intranodal tumor deposits with a ratio >75%, whereas no nodes or tumor deposits smaller than 5 mm were detected. The spatial resolution limitations of FDG-PET were responsible for 16 of 20 (80%) false-negative PET results in lymph nodes.
FDG-PET is a useful tool for preoperative evaluation of the neck because it accurately detects metastatic lymph nodes > or =10 mm and has fewer false-positive cases than CT. The high specificity of FDG-PET for lymph node metastases may play an important role in avoiding unnecessary neck dissection.
评估氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）相对于计算机断层扫描（CT）检测头颈部鳞状细胞癌（HNSCC）患者颈部转移性淋巴结的诊断准确性，并确定影响该准确性的因素。
回顾性分析26例术前接受FDG-PET和CT检查的HNSCC患者35次颈部清扫获取的1076个淋巴结。对于病理诊断为转移性的淋巴结，组织学记录淋巴结大小（短轴直径）、结内肿瘤沉积比例以及结内肿瘤沉积大小（每个淋巴结转移灶的最大直径）。
23侧颈部的46个淋巴结经病理诊断为转移灶。每侧颈部单独评估时，FDG-PET的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为74%、92%、80%、94%和65%，而CT的相应值分别为78%、58%、71%、78%和58%。FDG-PET检测出100%直径大于或等于10mm、结内肿瘤沉积大于或等于9mm以及结内肿瘤沉积比例大于75%的转移性淋巴结，而未检测到小于5mm的淋巴结或肿瘤沉积。FDG-PET的空间分辨率限制导致20例假阴性PET结果中的16例（80%）出现在淋巴结中。
FDG-PET是术前评估颈部的有用工具，因为它能准确检测直径大于或等于10mm的转移性淋巴结，且假阳性病例比CT少。FDG-PET对淋巴结转移的高特异性可能在避免不必要的颈部清扫中发挥重要作用。
