de Koekkoek-Doll Petra K, Roberti Sander, Smit Laura, Vogel Wouter V, Beets-Tan Regina, van den Brekel Michiel W, Castelijns Jonas
Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
Cancers (Basel). 2022 Aug 20;14(16):4019. doi: 10.3390/cancers14164019.
Nodal staging (N-staging) in head and neck squamous cell carcinoma (HNSCC) is essential for treatment planning and prognosis. 18F-fluordeoxyglucose positron emission tomography (FDG-PET) has high performance for N-staging, although the distinction between cytologically malignant and reactive PET-positive nodes, and consequently, the selection of nodes for ultrasound-guided fine needle aspiration cytology (USgFNAC), is challenging. Diffusion-weighted magnetic resonance imaging (DW-MRI) can help to detect nodal metastases. We aim to investigate the potential of the apparent diffusion coefficient (ADC) as a metric to distinguish between cytologically reactive and malignant PET-positive nodes in order to improve node selection criteria for USgFNAC. PET-CT, real-time image-fused USgFNAC and DW-MRI to calculate ADC were available for 78 patients offered for routine N-staging. For 167 FDG-positive nodes, differences in the ADC between cytologically benign and malignant PET-positive nodes were evaluated, and both were compared to the ADC values of PET-negative reference nodes. Analyses were also performed in subsets of nodes regarding HPV status. A mild negative correlation between SUVmax and ADC was found. No significant differences in ADC values were observed between cytologically malignant and benign PET-positive nodes overall. Within the subset of non-HPV-related nodes, ADC was significantly lower in cytologically malignant PET-positive nodes when compared to benign PET-positive nodes. ADC and ADCb were significantly lower ( = 0.018, 0.016, resp.) in PET-negative reference nodes than in PET-positive nodes. ADC was significantly higher in PET-negative reference nodes than in PET-positive nodes. The non-HPV-related subgroup showed significantly ( = 0.03) lower ADC values in cytologically malignant than in cytologically benign PET-positive nodes, which should help inform the node selection procedure for puncture.
头颈部鳞状细胞癌（HNSCC）的淋巴结分期（N分期）对于治疗方案的制定和预后评估至关重要。18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在N分期方面具有较高的性能，尽管在细胞学上区分恶性和反应性PET阳性淋巴结以及因此选择用于超声引导下细针穿刺细胞学检查（USgFNAC）的淋巴结具有挑战性。扩散加权磁共振成像（DW-MRI）有助于检测淋巴结转移。我们旨在研究表观扩散系数（ADC）作为区分细胞学反应性和恶性PET阳性淋巴结的指标的潜力，以改善USgFNAC的淋巴结选择标准。78例接受常规N分期的患者可进行PET-CT、实时图像融合USgFNAC和DW-MRI以计算ADC。对于167个FDG阳性淋巴结，评估了细胞学良性和恶性PET阳性淋巴结之间ADC的差异，并将两者与PET阴性参考淋巴结的ADC值进行比较。还对HPV状态相关的淋巴结亚组进行了分析。发现SUVmax与ADC之间存在轻度负相关。总体而言，细胞学恶性和良性PET阳性淋巴结之间的ADC值未观察到显著差异。在非HPV相关淋巴结亚组中，细胞学恶性PET阳性淋巴结的ADC明显低于良性PET阳性淋巴结。PET阴性参考淋巴结的ADC和ADCb明显低于PET阳性淋巴结（分别为P = 0.018，0.016）。PET阴性参考淋巴结的ADC明显高于PET阳性淋巴结。非HPV相关亚组中，细胞学恶性PET阳性淋巴结的ADC值明显低于细胞学良性PET阳性淋巴结（P = 0.03），这有助于为穿刺的淋巴结选择程序提供参考。
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