Abgral Ronan, Querellou Solène, Potard Gaël, Le Roux Pierre-Yves, Le Duc-Pennec Alexandra, Marianovski Remi, Pradier Olivier, Bizais Yves, Kraeber-Bodéré Françoise, Salaun Pierre Y
Nuclear Medicine Department, University Hospital of Brest, Brest, France.
J Nucl Med. 2009 Jan;50(1):24-9. doi: 10.2967/jnumed.108.055806. Epub 2008 Dec 17.
Posttreatment surveillance for the recurrence of head and neck squamous cell carcinoma (HNSCC) is a diagnostic challenge. Tissue distortion from radiation and surgery can obscure early detection of recurrence by conventional follow-up approaches such as physical examination, CT, and MRI. Several studies have shown that 18F-FDG PET may be an effective technique for the detection of persistent, recurrent, and distant metastatic HNSCC after treatment. The aim of this prospective study was to determine the benefits of hybrid 18F-FDG PET/CT in detecting a subclinical locoregional recurrence of HNSCC and distant metastases. The study patients were considered cured of HNSCC on the basis of 12 mo of negative findings on conventional follow-up. We also assessed the diagnostic accuracy of 18F-FDG PET/CT in these patients.
Ninety-one patients cured of HNSCC without any clinical evidence of recurrence were included. Whole-body 18F-FDG PET/CT examination was performed 11.6+/-4.4 mo after the end of the treatment. The gold standard was histopathology or 6 mo of imaging follow-up.
The whole-body 18F-FDG PET/CT examinations had negative results in 52 patients and positive results in 39. Nine of these patients who exhibited abnormal 18F-FDG uptake in the head and neck area did not have recurrent HNSCC (false-positive). Thirty had proven recurrence. The sensitivity and specificity of 18F-FDG PET/CT in this study for the diagnosis of HNSCC recurrence were 100% (30/30) and 85% (52/61), respectively. The positive predictive value was 77% (30/39). The negative predictive value was 100% (52/52). The overall accuracy was 90% (82/91).
The results of our study confirm the high effectiveness of 18F-FDG PET/CT in the assessment of HNSCC recurrence and suggest that 18F-FDG PET/CT is more accurate than conventional follow-up physical examination alone in the assessment of recurrence after previous curative treatment for HNSCC and could be proposed systematically at 12 mo of the usual follow-up.
头颈部鳞状细胞癌（HNSCC）治疗后复发的监测是一项诊断挑战。放疗和手术导致的组织变形会妨碍通过体格检查、CT和MRI等传统随访方法早期发现复发。多项研究表明，18F-FDG PET可能是检测治疗后持续性、复发性和远处转移性HNSCC的有效技术。这项前瞻性研究的目的是确定18F-FDG PET/CT在检测HNSCC亚临床区域复发和远处转移方面的益处。基于常规随访12个月无异常发现，研究患者被认为HNSCC已治愈。我们还评估了18F-FDG PET/CT在这些患者中的诊断准确性。
纳入91例已治愈HNSCC且无任何复发临床证据的患者。在治疗结束后11.6±4.4个月进行全身18F-FDG PET/CT检查。金标准为组织病理学或6个月的影像学随访。
全身18F-FDG PET/CT检查结果阴性的有52例，阳性的有39例。其中9例头颈部区域18F-FDG摄取异常的患者并无HNSCC复发（假阳性）。30例确诊为复发。本研究中18F-FDG PET/CT诊断HNSCC复发的敏感性和特异性分别为100%（30/30）和85%（52/61）。阳性预测值为77%（30/39）。阴性预测值为100%（52/52）。总体准确率为90%（82/91）。
我们的研究结果证实了18F-FDG PET/CT在评估HNSCC复发方面的高效性，并表明在评估既往HNSCC根治性治疗后的复发时，18F-FDG PET/CT比单纯的传统随访体格检查更准确，可在常规随访12个月时系统地推荐使用。
