Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
Ann Otol Rhinol Laryngol. 2023 Oct;132(10):1133-1139. doi: 10.1177/00034894221135934. Epub 2022 Dec 1.
To compare the utility of positron emission tomography-computed tomography (PET-CT) versus contrasted CT neck combined with routine chest imaging for disease staging and treatment planning in human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) with clinically evident sites of primary disease.
All adult patients with primary HPV-associated OPSCC at a single quaternary care cancer center from 2018 to 2019 were reviewed, and those with images available for re-review were included. Primary outcomes included concordance in clinical staging between the 2 imaging modalities of interest (PET-CT vs CT), as well as independent agreement of each with pathologic staging. Analysis was performed via ordinal logistic regression. A secondary outcome was treatment selection after diagnostic imaging, analyzed via chi-squared testing.
In total, 100 patients were included for evaluation, of which 89% were male, 91% Caucasian, and mean age was 61.2 years (SD 9.6). Clinical disease staging agreed between imaging modalities in 95% of cases (54 of 57 patients). Pathologic staging agreed with clinical staging from CT neck in 93% of cases (25 of 27 patients; = .004), and with PET-CT in 82% (14 of 17 patients; .003). No differences were observed between the 2 imaging modalities for subsequent treatment selection ( = .39).
In uncomplicated HPV-associated OPSCC, CT offers equivalent diagnostic accuracy to that of combined whole-body PET-CT for clinical staging, and has no appreciable impact on treatment selection. A reduced reliance on routine PET-CT during initial workup of HPV-associated OPSCC may be favorable for otherwise healthy patients with clinically evident sites of primary disease.
比较正电子发射断层扫描计算机断层扫描（PET-CT）与对比增强 CT 颈部联合常规胸部成像在伴有临床明显原发部位疾病的人乳头瘤病毒（HPV）相关口咽鳞状细胞癌（OPSCC）中的疾病分期和治疗计划中的应用。
回顾了 2018 年至 2019 年在单一四级癌症中心接受原发性 HPV 相关 OPSCC 治疗的所有成年患者，并对可进行重新评估的图像进行了评估。主要结局包括两种感兴趣的影像学检查（PET-CT 与 CT）之间的临床分期一致性，以及每种影像学检查与病理分期的独立一致性。采用有序逻辑回归进行分析。次要结局是诊断性影像学检查后的治疗选择，采用卡方检验进行分析。
共纳入 100 例患者进行评估，其中 89%为男性，91%为白种人，平均年龄为 61.2 岁（标准差 9.6）。95%的病例影像学检查结果的临床疾病分期一致（57 例中有 54 例）。93%的病例 CT 颈部的病理分期与临床分期一致（27 例中有 25 例； = .004），82%的病例 PET-CT 与临床分期一致（17 例中有 14 例；.003）。两种影像学检查方法在后续治疗选择上无差异（ = .39）。
在不复杂的 HPV 相关 OPSCC 中，CT 在临床分期方面与全身 PET-CT 联合检查具有相当的诊断准确性，并且对治疗选择没有明显影响。在 HPV 相关 OPSCC 的初步检查中减少对常规 PET-CT 的依赖，可能对具有临床明显原发部位疾病且身体健康的患者有利。
