Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom.
J Clin Oncol. 2017 Oct 20;35(30):3458-3464. doi: 10.1200/JCO.2017.73.5845. Epub 2017 Aug 30.
Purpose To assess the standardized implementation and reporting of surveillance [F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan of the neck in locoregionally advanced head-and-neck squamous cell carcinoma (LAHNSCC) after concurrent chemoradiotherapy (CCRT). Patients and Methods We performed a prospective multicenter study of FDG-PET/CT scanning 12 weeks after CCRT in newly diagnosed patients with LAHNSCC (stage IVa/b) that used standardized reconstruction and Hopkins reporting criteria. The reference standard was histology or > 12 months of clinical follow-up. The primary outcome measure was the negative predictive value (NPV) of FDG-PET/CT scans and other supporting diagnostic test characteristics, including time dependency with increasing follow-up time. Results Of 152 patients, 125 had adequate primary tumor control after CCRT and entered follow-up (median, 20.4 months). Twenty-three (18.4%) had residual neck disease. Overall, NPV was 92.1% (95% CI, 86.9% to 95.3%; null hypothesis: NPV = 85%; P = .012) with sensitivity of 65.2% (95% CI, 44.9% to 81.2%), specificity of 91.2% (95% CI, 84.1% to 95.3%), positive predictive value of 62.5% (95% CI, 45.5% to 76.9%), and accuracy of 86.4% (95% CI, 79.3% to 91.3%). Sensitivity was time dependent and high for residual disease manifesting up to 9 months after imaging but lower (59.7%) for disease detected up to 12 months after imaging. Standardized reporting criteria reduced the number of equivocal reports (95% CI for the difference, 2.6% to 15.0%; P = .003). Test characteristics were not improved with the addition of lymph node CT morphology criteria. Conclusion FDG-PET/CT surveillance using Hopkins criteria 12 weeks after CCRT is reliable in LAHNSCC except for late manifesting residual disease, which may require an additional surveillance scan at 1 year after CCRT to be detected.
目的 评估同步放化疗后局部晚期头颈部鳞状细胞癌（LAHNSCC）患者颈部监测 [F]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）的标准化实施和报告。
方法 我们对新诊断的 IVa/b 期 LAHNSCC 患者进行了前瞻性多中心研究，在同步放化疗后 12 周行 FDG-PET/CT 扫描，使用标准化重建和霍普金斯报告标准。参考标准为组织学或 >12 个月的临床随访。主要观察指标是 FDG-PET/CT 扫描的阴性预测值（NPV）和其他支持性诊断测试特征，包括随时间推移的依赖性，即随着随访时间的增加。
结果 在 152 例患者中，125 例患者在同步放化疗后肿瘤得到了充分控制并进入随访（中位数 20.4 个月）。23 例（18.4%）患者颈部仍有残留疾病。总体而言，NPV 为 92.1%（95%CI，86.9%至 95.3%；零假设：NPV=85%；P=0.012），灵敏度为 65.2%（95%CI，44.9%至 81.2%），特异性为 91.2%（95%CI，84.1%至 95.3%），阳性预测值为 62.5%（95%CI，45.5%至 76.9%），准确性为 86.4%（95%CI，79.3%至 91.3%）。灵敏度与时间有关，在影像学表现后 9 个月内检测到残留疾病的灵敏度较高（95%CI 差异，2.6%至 15.0%；P=0.003），但在影像学表现后 12 个月内检测到残留疾病的灵敏度较低（59.7%）。使用标准化报告标准减少了不确定报告的数量（95%CI 差异，2.6%至 15.0%；P=0.003）。添加淋巴结 CT 形态学标准并不能提高测试特征。
结论 除了晚期表现的残留疾病外，LAHNSCC 患者在同步放化疗后 12 周使用霍普金斯标准进行 FDG-PET/CT 监测是可靠的，后者可能需要在同步放化疗后 1 年进行额外的监测扫描才能发现。
