Gourin Christine G, Watts Tammara, Williams Hadyn T, Patel Vijay S, Bilodeau Paul A, Coleman Teresa A
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Laryngoscope. 2009 Apr;119(4):703-6. doi: 10.1002/lary.20118.
To investigate the utility of positron-emission tomography/computed tomography (PET-CT) in identifying distant metastatic disease in patients with suspected recurrent head and neck squamous cell cancer (HNSCC).
Retrospective analysis.
Retrospective analysis of 64 consecutive patients with suspected recurrent HNSCC following definitive treatment who underwent PET-CT imaging were eligible for inclusion. Patients with previous known distant metastatic disease were excluded.
The majority of patients (81%) had TNM stage III or IV disease. PET-CT was suspicious for pulmonary malignancy in 14 patients (22%) and indeterminate in 6 patients (9%). Pulmonary metastases or a new lung primary were present in 10 patients (16%): 7 of 14 patients with positive PET-CT scans (50%) and 3 of 50 patients with negative or indeterminate PET-CT scans (6%). Including nonpulmonary sites, the overall incidence of distant disease was 23% (15/64) with 20% (13/64) unsuspected prior to PET-CT. The sensitivity and specificity of PET-CT in predicting distant malignancy was 86% and 84%, respectively, with a positive predictive value of 60% and a negative predictive value of 95%. There was a significant correlation between standardized uptake value (SUV) on PET-CT and positive histology, with a mean SUV of 8.5 (range, 4.7-16.2) in patients with distant metastases compared with a mean SUV of 2.9 (range, 1.9-4.2) in patients with benign pathology (r = 0.87, P < .0001).
A significant number of patients with recurrent HNSCC have distant metastases at the time of recurrence. These data suggest that PET-CT improves detection of metastatic disease in the high-risk patient and should be performed as part of the routine evaluation of patients with suspected recurrence prior to salvage surgery.
探讨正电子发射断层扫描/计算机断层扫描（PET-CT）在识别疑似复发性头颈部鳞状细胞癌（HNSCC）患者远处转移性疾病中的应用价值。
回顾性分析。
对64例接受确定性治疗后疑似复发性HNSCC且接受PET-CT成像的连续患者进行回顾性分析，符合纳入标准。排除既往已知有远处转移性疾病的患者。
大多数患者（81%）为TNM III期或IV期疾病。PET-CT对14例患者（22%）的肺部恶性肿瘤可疑，6例患者（9%）结果不确定。10例患者（16%）存在肺转移或新发肺原发性肿瘤：PET-CT扫描阳性的14例患者中有7例（50%），PET-CT扫描阴性或不确定的50例患者中有3例（6%）。包括非肺部部位，远处疾病的总发生率为23%（15/64），其中20%（13/64）在PET-CT检查前未被怀疑。PET-CT预测远处恶性肿瘤的敏感性和特异性分别为86%和84%，阳性预测值为60%，阴性预测值为95%。PET-CT上的标准化摄取值（SUV）与阳性组织学之间存在显著相关性，远处转移患者的平均SUV为8.5（范围4.7-16.2），而良性病理患者的平均SUV为2.9（范围1.9-4.2）（r = 0.87，P <.0001）。
相当数量的复发性HNSCC患者在复发时存在远处转移。这些数据表明，PET-CT可提高高危患者转移性疾病的检测率，应作为疑似复发患者在挽救性手术前常规评估的一部分进行检查。
