Mohammadzadeh S, Mohebbi A, Moradi Z, Ardakani A A, Mohammadi A, Tavangar S M
Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Radiography (Lond). 2025 Mar;31(2):102902. doi: 10.1016/j.radi.2025.102902. Epub 2025 Feb 26.
Assessing local invasion is essential for determining stage of cN0 head and neck squamous cell carcinoma (HNSCC). We aimed to evaluate the performance of fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) in HNSCC characterization and compare it with conventional imaging.
This multicentral study included 278 consecutive newly diagnosed cN0 HNSCC patients recruited from ACRIN 6685 (American College of Radiology Imaging Network) dataset. Four board-certified nuclear radiologists interpreted preoperative PET/CT, MRI, and CT examinations of patients. Imaging results were compared to pathological reference tests through area under curve (AUC), sensitivity, specificity, and receiver operating characteristic (ROC) curve using Stata 18 and Medcalc 22.017.
PET/CT demonstrated 23.5 %, 24.7 %, and 51.6 % upstaging, downstaging, and same staging in T staging of patients in comparison to histopathological evaluation, respectively. When evaluating N status, PET/CT showed 25.7 % upstaging, 20.3 % downstaging, and 53.9 % same staging. An optimal SUV cut-off value of 10.9 was determined to predict early-stage (T1, T2) and advanced-stage (T3, T4) HNSCC tumors with an AUC of 0.709 (95 % CI = 0.648-0.766). This cut-off value also predicted N0 and N+ patients with an AUC of 0.670 (95 % CI = 0.606-0.729). Sensitivity and specificity of PET/CT, MRI, and CT for bone invasion, muscle invasion, nerve invasion, cartilage invasion, superficial tissue invasion, overall invasion, and fixed vocal cord were calculated.
Our findings support the valuable accuracy of 18F-FDG PET/CT in staging HNSCC patients. Also, 18F-FDG PET/CT outperformed conventional imaging in characterization of HNSCC tumors.
By offering an in-depth investigation in imaging of HNSCC tumors, this study contributes to evidence-based clinical decision-making.
评估局部侵犯对于确定cN0期头颈部鳞状细胞癌（HNSCC）的分期至关重要。我们旨在评估氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）在HNSCC特征描述中的表现，并将其与传统成像进行比较。
这项多中心研究纳入了从ACRIN 6685（美国放射学会成像网络）数据集中连续招募的278例新诊断的cN0期HNSCC患者。四位获得委员会认证的核放射科医生解读了患者的术前PET/CT、MRI和CT检查结果。使用Stata 18和Medcalc 22.017通过曲线下面积（AUC）、敏感性、特异性和受试者工作特征（ROC）曲线将成像结果与病理参考测试进行比较。
与组织病理学评估相比，PET/CT在患者T分期中分别显示23.5%、24.7%和51.6%的分期上调、分期下调和分期相同。在评估N状态时，PET/CT显示25.7%的分期上调、20.3%的分期下调和53.9%的分期相同。确定最佳SUV临界值为10.9，以预测早期（T1、T2）和晚期（T3、T4）HNSCC肿瘤，AUC为0.709（95%CI = 0.648-0.766）。该临界值还预测N0和N+患者，AUC为0.670（95%CI = 0.606-0.729）。计算了PET/CT、MRI和CT对骨侵犯、肌肉侵犯、神经侵犯、软骨侵犯、浅表组织侵犯、总体侵犯和声带固定的敏感性和特异性。
我们的研究结果支持18F-FDG PET/CT在HNSCC患者分期中的高准确性。此外，18F-FDG PET/CT在HNSCC肿瘤特征描述方面优于传统成像。
通过对HNSCC肿瘤成像进行深入研究，本研究有助于基于证据的临床决策。
