Rohde Max, Nielsen Anne L, Johansen Jørgen, Sørensen Jens A, Nguyen Nina, Diaz Anabel, Nielsen Mie K, Asmussen Jon T, Christiansen Janus M, Gerke Oke, Thomassen Anders, Alavi Abass, Høilund-Carlsen Poul Flemming, Godballe Christian
Department of ORL-Head & Neck Surgery, Odense University Hospital, Odense, Denmark
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
J Nucl Med. 2017 Dec;58(12):1919-1924. doi: 10.2967/jnumed.117.189704. Epub 2017 Jun 1.
The purpose of this study was to determine the detection rate of distant metastasis and synchronous cancer, comparing clinically used imaging strategies based on chest x-ray + head and neck MRI (CXR/MRI) and chest CT + head and neck MRI (CHCT/MRI) with F-FDG PET/CT upfront in the diagnostic workup of patients with oral, pharyngeal, or laryngeal cancer. This was a prospective cohort study based on paired data. Consecutive patients with histologically verified primary head and squamous cell carcinoma at Odense University Hospital from September 2013 to March 2016 were considered for the study. Included patients underwent CXR/MRI and CHCT/MRI as well as PET/CT on the same day and before biopsy. Scans were read masked by separate teams of experienced nuclear physicians or radiologists. The true detection rate of distant metastasis and synchronous cancer was assessed for CXR/MRI, CHCT/MRI, and PET/CT. A total of 307 patients were included. CXR/MRI correctly detected 3 (1%) patients with distant metastasis, CHCT/MRI detected 11 (4%) patients, and PET/CT detected 18 (6%) patients. The absolute differences of 5% and 2%, respectively, were statistically significant in favor of PET/CT. Also, PET/CT correctly detected 25 (8%) synchronous cancers, which was significantly more than CXR/MRI (3 patients, 1%) and CHCT/MRI (6 patients, 2%). The true detection rate of distant metastasis or synchronous cancer with PET/CT was 13% (40 patients), which was significantly higher than 2% (6 patients) for CXR/MRI and 6% (17 patients) for CHCT/MRI. A clinical imaging strategy based on PET/CT demonstrated a significantly higher detection rate of distant metastasis or synchronous cancer than strategies in current clinical imaging guidelines, of which European ones primarily recommend CXR/MRI, whereas U.S. guidelines preferably point to CHCT/MRI in patients with head and neck squamous cell carcinoma.
本研究的目的是确定远处转移和同步癌的检出率，在口腔、咽或喉癌患者的诊断检查中，将基于胸部X光+头颈部MRI（CXR/MRI）和胸部CT+头颈部MRI（CHCT/MRI）的临床常用成像策略与先行F-FDG PET/CT进行比较。这是一项基于配对数据的前瞻性队列研究。2013年9月至2016年3月在欧登塞大学医院连续纳入组织学确诊为原发性头颈部鳞状细胞癌的患者进行研究。纳入的患者在同一天且在活检前接受了CXR/MRI、CHCT/MRI以及PET/CT检查。扫描结果由经验丰富的核医学医师或放射科医生组成的独立团队进行盲法解读。评估了CXR/MRI、CHCT/MRI和PET/CT对远处转移和同步癌的真实检出率。共纳入307例患者。CXR/MRI正确检测出3例（1%）有远处转移的患者，CHCT/MRI检测出11例（4%）患者，PET/CT检测出1例（6%）患者。分别为5%和2%的绝对差异在支持PET/CT方面具有统计学意义。此外，PET/CT正确检测出25例（8%）同步癌，显著多于CXR/MRI（3例患者，1%）和CHCT/MRI（6例患者，2%）。PET/CT对远处转移或同步癌的真实检出率为13%（40例患者），显著高于CXR/MRI的2%（6例患者）和CHCT/MRI的6%（17例患者）。基于PET/CT的临床成像策略显示，其对远处转移或同步癌的检出率显著高于当前临床成像指南中的策略，其中欧洲指南主要推荐CXR/MRI，而美国指南在头颈部鳞状细胞癌患者中更倾向于CHCT/MRI。
