胸部 X 线摄影或胸部 CT 加头颈部 CT 与 F-FDG PET/CT 用于检测头颈部癌症患者的远处转移和同步癌。
Chest radiography or chest CT plus head and neck CT versus F-FDG PET/CT for detection of distant metastasis and synchronous cancer in patients with head and neck cancer.
机构信息
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Oral Oncol. 2019 Jan;88:109-114. doi: 10.1016/j.oraloncology.2018.11.026. Epub 2018 Nov 23.
OBJECTIVES
Current guidelines recommend chest computed tomography (CT) with locoregional CT/magnetic resonance imaging for patients with head and neck squamous cell carcinoma (HNSCC), and F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/CT is suggested for stage III-IV patients. However, whole body screening with F-FDG PET/CT may provide better detection of distant metastases and synchronous cancer than conventional imaging. We evaluated the utility of F-FDG PET/CT in detecting distant metastasis and synchronous cancer.
METHODS
This prospective study enrolled 740 consecutive patients with previously untreated HNSCC diagnosed between September 2010 and December 2015. Synchronous cancer was histologically confirmed and distant metastases were confirmed by biopsy or serial imaging follow-ups. McNemar test was used to compare the true-positive detection rates of chest radiography (CXR) + head and neck CT (hnCT) (A) versus F-FDG PET/CT (C) and chest CT + hnCT (B) versus F-FDG PET/CT.
RESULTS
Distant metastases and synchronous cancer were found in 23 (3.1%) and 55 (7.4%) patients, respectively. A, B, and C detected distant metastases in 10 (1.3%), 19 (2.6%), and 21 (2.8%) patients, respectively. The absolute differences were 1.5% (A versus C, P = 0.003) and 0.3% (B versus C, P = 0.687). A, B, and C detected synchronous cancer in 15 (2.0%), 22 (2.9%), and 36 (4.9%) patients, respectively. The absolute differences were 2.8% (A versus C, P < 0.001) and 1.4% (B versus C, P = 0.013).
CONCLUSIONS
F-FDG PET/CT detected more distant metastases and synchronous cancer than CXR + hnCT and more synchronous cancer than chest CT + hnCT.
目的
目前的指南建议对头颈鳞状细胞癌（HNSCC）患者进行胸部计算机断层扫描（CT）加局部 CT/磁共振成像，建议对 III-IV 期患者进行 F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT。然而，全身 F-FDG PET/CT 筛查可能比常规影像学检查能更好地发现远处转移和同时性癌症。我们评估了 F-FDG PET/CT 在检测远处转移和同时性癌症方面的效用。
方法
这项前瞻性研究纳入了 740 例 2010 年 9 月至 2015 年 12 月期间未经治疗的 HNSCC 连续患者。同时性癌症经组织学证实，远处转移经活检或连续影像学随访证实。采用 McNemar 检验比较胸部 X 线摄影（CXR）+头颈部 CT（hnCT）（A）与 F-FDG PET/CT（C）以及胸部 CT+hnCT（B）与 F-FDG PET/CT 的真阳性检出率。
结果
23 例（3.1%）和 55 例（7.4%）患者分别发现远处转移和同时性癌症。A、B 和 C 分别检测到 10 例（1.3%）、19 例（2.6%）和 21 例（2.8%）远处转移。绝对差值分别为 1.5%（A 与 C，P=0.003）和 0.3%（B 与 C，P=0.687）。A、B 和 C 分别检测到 15 例（2.0%）、22 例（2.9%）和 36 例（4.9%）同时性癌症。绝对差值分别为 2.8%（A 与 C，P<0.001）和 1.4%（B 与 C，P=0.013）。
结论
与 CXR+hnCT 相比，F-FDG PET/CT 检测到更多的远处转移和同时性癌症，与胸部 CT+hnCT 相比，F-FDG PET/CT 检测到更多的同时性癌症。
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