Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK.
Clin Radiol. 2012 Oct;67(10):966-75. doi: 10.1016/j.crad.2012.02.016. Epub 2012 May 15.
To analyse the diagnostic accuracy of delayed response assessment 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography-computed tomography (PET-CT) following (chemo)radiation for locally advanced head and neck squamous cell carcinoma (HNSCC).
Forty-four consecutive patients who underwent a baseline and response assessment using FDG PET-CT for HNSCC following (chemo)radiation between August 2008 and April 2011 were identified retrospectively. Clinicopathological findings and serial clinical follow-up provided the reference standard.
Median follow-up was 14 months (range 5-43 months). Response assessment FDG PET-CT was performed at 16.8 weeks (inter-quartile range 15.8-18.6 weeks). Thirty-one out of 44 (70%) response assessment examinations showed a complete metabolic response. Seven out of 40 (18%) assessable primary tumours were positive. Eight out of 41 (20%) patients with pre-treatment nodal disease had equivocal or positive FDG uptake at response assessment. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for primary disease and nodal disease were 100, 89, 43, 100, and 100%, and 92, 63, and 100%, respectively. Seven patients had residual FDG-negative soft tissue detectable on the unenhanced CT component of the response assessment images; all remained disease free after clinical observation. Distant metastases were detected on response assessment FDG PET-CT in four out of the 44 patients (10%).
The diagnostic accuracy of response assessment with FDG PET-CT performed at approximately 16 weeks post-(chemo)radiotherapy is good. The very high NPV of a complete metabolic response can be used to guide management decisions. Although the PPV is limited for local residual disease, FDG PET-CT is a powerful screening tool for the detection of interim metastatic disease.
分析局部晚期头颈部鳞状细胞癌（HNSCC）放化疗后延迟反应评估 2-[¹⁸F]-氟-2-脱氧-d-葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）的诊断准确性。
回顾性分析了 2008 年 8 月至 2011 年 4 月期间接受 FDG PET-CT 基线和反应评估的 44 例连续局部晚期头颈部鳞状细胞癌（HNSCC）放化疗患者。临床病理发现和连续临床随访提供了参考标准。
中位随访时间为 14 个月（5-43 个月）。FDG PET-CT 反应评估在 16.8 周进行（四分位间距 15.8-18.6 周）。44 例中有 31 例（70%）反应评估检查显示完全代谢反应。可评估的 40 个原发肿瘤中有 7 个（18%）呈阳性。41 例有治疗前淋巴结疾病的患者中，8 例在反应评估时摄取 FDG 呈不确定或阳性。原发疾病和淋巴结疾病的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 100%、89%、43%、100%和 100%、92%、63%和 100%。在反应评估的 FDG PET-CT 上，7 例患者可检测到残留的 FDG 阴性软组织；所有患者在临床观察后均无疾病。在 44 例患者中，有 4 例在反应评估 FDG PET-CT 上发现远处转移。
放化疗后约 16 周行 FDG PET-CT 反应评估的诊断准确性良好。完全代谢反应的极高 NPV 可用于指导管理决策。虽然局部残留疾病的 PPV 有限，但 FDG PET-CT 是检测中期转移性疾病的有力筛查工具。
