Lee Hwan Seo, Kim Jae Seung, Roh Jong-Lyel, Choi Seung-Ho, Nam Soon Yuhl, Kim Sang Yoon
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur J Radiol. 2014 Aug;83(8):1455-60. doi: 10.1016/j.ejrad.2014.05.020. Epub 2014 May 27.
Fluorine 18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) is used to identify index or second primary cancer (SP) of the head and neck (HN) through changes in (18)F-FDG uptake. However, both physiologic and abnormal lesions increase (18)F-FDG uptake. Therefore, we evaluated (18)F-FDG uptake in the HN region to determine clinical values of abnormal tracer uptake.
A prospective study approved by the institutional review board was conducted in 314 patients with newly diagnosed HN squamous cell carcinoma (HNSCC) and informed consent was obtained from all enrolled patients. The patients received initial staging workups including (18)F-FDG PET/CT and biopsies. All lesions with abnormal HN (18)F-FDG uptake were recorded and most of those were confirmed by biopsies. Diagnostic values for abnormal (18)F-FDG uptake were calculated.
Abnormal (18)F-FDG uptake was identified in primary tumors from 285 (91.9%) patients. False-negative results were obtained for 22.3% (23/103) T1 tumors and 2.2% (2/93) T2 tumors (P<0.001). Thirty-eight regions of abnormal (18)F-FDG uptake were identified in 36 (11.5%) patients: the thyroid (n=13), maxillary sinus (n=7), palatine tonsil (n=6), nasopharynx (n=5), parotid gland (n=2) and others (n=5). Synchronous SP of the HN was identified in eight (2.5%) patients: the thyroid (n=5), palatine tonsil (n=2), and epiglottis (n=1). The sensitivity and specificity of (18)F-FDG PET/CT for identification of SPs were 75.0% and 98.7%, respectively.
(18)F-FDG PET/CT is a reliable method for tumor staging and identify SP in HN region, promoting appropriate therapeutic planning. Additional examinations may be required to identify superficial or small-volume tumors.
氟代脱氧葡萄糖（18F-FDG）正电子发射断层显像（PET）/计算机断层扫描（CT）通过18F-FDG摄取的变化来识别头颈部（HN）的原发癌或第二原发癌（SP）。然而，生理性和异常病变均会增加18F-FDG摄取。因此，我们评估了HN区域的18F-FDG摄取情况，以确定异常示踪剂摄取的临床价值。
一项经机构审查委员会批准的前瞻性研究纳入了314例新诊断的HN鳞状细胞癌（HNSCC）患者，所有入组患者均获得了知情同意。患者接受了包括18F-FDG PET/CT和活检在内的初始分期检查。记录所有HN区域18F-FDG摄取异常的病变，其中大多数经活检证实。计算异常18F-FDG摄取的诊断价值。
285例（91.9%）患者的原发肿瘤中发现18F-FDG摄取异常。T1肿瘤的假阴性率为22.3%（23/103），T2肿瘤为2.2%（2/93）（P<0.001）。36例（11.5%）患者中发现38个18F-FDG摄取异常区域：甲状腺（n=13）、上颌窦（n=7）、腭扁桃体（n=6）、鼻咽（n=5）、腮腺（n=2）和其他部位（n=5）。8例（2.5%）患者中发现HN区域同步SP：甲状腺（n=5）、腭扁桃体（n=2）和声门（n=1）。18F-FDG PET/CT识别SP的敏感性和特异性分别为75.0%和98.7%。
¹⁸F-FDG PET/CT是一种可靠的肿瘤分期方法，可用于识别HN区域的SP，有助于制定合适的治疗方案。对于表浅或小体积肿瘤，可能需要进行额外检查。
