Strobel Klaus, Haerle Stephan K, Stoeckli Sandro J, Schrank Madeleine, Soyka Jan D, Veit-Haibach Patrick, Hany Thomas F
Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland.
Eur J Nucl Med Mol Imaging. 2009 Jun;36(6):919-27. doi: 10.1007/s00259-009-1064-6. Epub 2009 Feb 10.
The aim of the study was to evaluate (18)F-FDG-PET/CT for the detection of synchronous primaries at initial staging of patients with head and neck squamous cell carcinoma (HNSCC).
FDG-PET/CT images acquired between March 2001 and October 2007 in 589 consecutive patients (147 women, 442 men; mean age 61.5 years, age range 32-97 years) with proven HNSCC were reviewed for the presence of synchronous primaries. Cytology, histology and/or clinical and imaging follow-up served as reference standard.
FDG-PET/CT showed 69 suspected synchronous primaries in 62 patients of which 56 were finally confirmed in 44 patients. Of the 56 second cancers, 46 (82%) were found in the aerodigestive tract in the following locations: lung (26, 46%), head and neck (15, 17%), oesophagus (5, 9%). Ten second cancers (18%) were located outside the aerodigestive tract (colon, five; stomach, lymphoma, breast, thymus and kidney, one each). Six patients had three synchronous primaries and three patients had four synchronous cancers. Nine synchronous cancers were not detected by PET/CT (four head and neck, two lung, two oesophageal, one gastric). False-positive PET/CT findings were mainly related to benign FDG uptake in the intestine due to benign or precancerous polyps or physiological FDG uptake in other head and neck regions. Overall the prevalence of synchronous second primaries according to the reference standard was 9.5%, of which 84% were detected with FDG-PET/CT. In 80% of the patients, therapy was changed because of the detection of a synchronous primary.
FDG-PET/CT detects a considerable number of synchronous primaries (8.0% prevalence) at initial staging of patients with HNSCC. Synchronous cancers were predominantly located in the aerodigestive tract, primarily in the lung, head and neck and oesophagus. Detection of second primaries has an important impact on therapy. PET/CT should be performed before panendoscopy.
本研究旨在评估¹⁸F-FDG-PET/CT在头颈部鳞状细胞癌（HNSCC）患者初始分期时检测同步原发肿瘤的价值。
回顾性分析2001年3月至2007年10月期间连续纳入的589例经证实的HNSCC患者（147例女性，442例男性；平均年龄61.5岁，年龄范围32 - 97岁）的FDG-PET/CT图像，以确定是否存在同步原发肿瘤。细胞学、组织学和/或临床及影像学随访作为参考标准。
FDG-PET/CT显示62例患者中有69个疑似同步原发肿瘤，其中44例患者的56个最终得到证实。在56个第二原发癌中，46个（82%）位于气道消化道，具体部位如下：肺（26个，46%）、头颈部（15个，17%）、食管（5个，9%）。10个第二原发癌（18%）位于气道消化道以外（结肠，5个；胃、淋巴瘤、乳腺、胸腺和肾脏各1个）。6例患者有3个同步原发肿瘤，3例患者有4个同步癌。9个同步癌未被PET/CT检测到（4个头颈部、2个肺部、2个食管、1个胃部）。PET/CT的假阳性结果主要与肠道内良性或癌前息肉导致的良性FDG摄取或其他头颈部区域的生理性FDG摄取有关。总体而言，根据参考标准，同步第二原发肿瘤的患病率为9.5%，其中84%通过FDG-PET/CT检测到。80%的患者因检测到同步原发肿瘤而改变了治疗方案。
FDG-PET/CT在HNSCC患者初始分期时可检测到相当数量的同步原发肿瘤（患病率8.0%）。同步癌主要位于气道消化道，主要是肺、头颈部和食管。第二原发肿瘤的检测对治疗有重要影响。PET/CT应在全面内镜检查之前进行。
