1 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9140.
2 Department of Otolaryngology and Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
AJR Am J Roentgenol. 2017 Aug;209(2):289-303. doi: 10.2214/AJR.17.18301.
The purpose of this article is to summarize the evidence for the value of PET/CT for the management of patients with head and neck squamous cell cancer and suggest best clinical practices.
FDG PET/CT is a valuable imaging tool for identifying unknown primary tumors in patients with known cervical node metastases leading to management change and is the standard of care for the initial staging of stage III and IV head and neck squamous cell carcinomas (HNSCCs), for assessing therapy response when performed at least 12 weeks after chemoradiation therapy, and for avoiding unnecessary planned neck dissection. Neck dissection is avoided if PET/CT findings are negative-regardless of the size of the residual neck nodes-because survival outcomes are not compromised. FDG PET/CT is valuable in detecting recurrences and metastases during follow-up when suspected because of clinical symptoms and serves as a prognostic marker for patient survival outcomes, for 5 years. Using FDG PET/CT for routine surveillance of HNSCC after 6 months of treatment without any clinical suspicion should be discouraged.
本文旨在总结正电子发射断层扫描/计算机断层扫描（PET/CT）在头颈部鳞状细胞癌患者管理中的价值证据，并提出最佳临床实践建议。
在已知颈部淋巴结转移的患者中，氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）是一种有价值的成像工具，可用于识别未知原发性肿瘤，从而改变治疗方案，并且是 III 期和 IV 期头颈部鳞状细胞癌（HNSCC）初始分期的标准治疗方法，在放化疗后至少 12 周进行评估治疗反应，避免不必要的计划颈部清扫术。如果 PET/CT 检查结果为阴性（无论残留颈部淋巴结的大小如何），则可避免颈部清扫术，因为生存结局不受影响。FDG PET/CT 在随访中怀疑有复发和转移时具有价值，因为它可根据临床症状进行检测，并作为预测患者生存结局的预后标志物，可预测 5 年的情况。在没有任何临床怀疑的情况下，在治疗后 6 个月后使用 FDG PET/CT 对 HNSCC 进行常规监测，应予以劝阻。
