Multicenter Trial of Positron Emission Tomography/Computed Tomography Staging of Head and Neck Cancer and Negative Predictive Value and Surgical Impact in the N0 Neck: Results From ACRIN 6685

PURPOSE The objective of this study was to determine the negative predictive value (NPV) of positron emission tomography (PET)/computed tomography (CT) for the clinically N0 neck on the basis of neck dissection. METHODS Participants with newly diagnosed, fi rst-time, head and neck squamous cell carcinoma (HNSCC) and at least one clinically N0 neck side for which dissection was planned were included. A total of 287 participants were prospectively enrolled from 23 American College of Radiology Imaging Network-quali fi ed institutions. PET/ CT was compared with fi ndings at neck dissection. value was determined to be 1.8, with an NPV of 0.942 (95% CI, 0.930 to 0.953). The PET/CT-informed surgical treatment plan was changed in 51 of 237 participants (22%) compared with the PET/CT-blinded surgical plan. In 34 participants (14%), this led to planned dissection of additional nodal levels. In 12 participants (5%), this led to fewer planned dissected nodal levels. Negative PET/ CT scans in N0 necks was true negative in 87% and false negative in 13%. may the in deciding on the best therapy for the clinically N0 neck in HNSCC. Well-designed clinical trials should be performed to test the outcome of omitting neck dissection by using PET/CT.

[1]  V. Lowe,et al.  Multicenter Trial of [18F]fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging of Head and Neck Cancer and Negative Predictive Value and Surgical Impact in the N0 Neck: Results From ACRIN 6685. , 2019, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  R. Shaw,et al.  Sentinel lymph node biopsy for oral squamous cell carcinoma. Where are we now? , 2017, The British journal of oral & maxillofacial surgery.

[3]  K. Wong,et al.  Positron emission tomography–CT prediction of occult nodal metastasis in recurrent laryngeal cancer , 2017, Head & neck.

[4]  T. Roques,et al.  Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines , 2016, The Journal of Laryngology & Otology.

[5]  R. Gilbert,et al.  Impact of elective neck dissection on the outcome of oral squamous cell carcinomas arising in the maxillary alveolus and hard palate , 2016, Head & neck.

[6]  Sudeep Gupta,et al.  Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer. , 2015, The New England journal of medicine.

[7]  J. Pijoan,et al.  Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis , 2015, European Journal of Nuclear Medicine and Molecular Imaging.

[8]  Laura Evangelista,et al.  Comparison between anatomical cross-sectional imaging and 18F-FDG PET/CT in the staging, restaging, treatment response, and long-term surveillance of squamous cell head and neck cancer: a systematic literature overview , 2014, Nuclear medicine communications.

[9]  R. Subramaniam,et al.  PET/CT mediastinal and liver FDG uptake: Effects of biological and procedural factors , 2013, Journal of medical imaging and radiation oncology.

[10]  J. vanderLei,et al.  Management of neck metastases in T2N0 lip squamous cell carcinoma. , 2013, American journal of otolaryngology.

[11]  Paul D. Campbell,et al.  The use of multiple time point dynamic positron emission tomography/computed tomography in patients with oral/head and neck cancer does not predictably identify metastatic cervical lymph nodes. , 2013, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[12]  A. Chauhan,et al.  Comparison of PET/CT with conventional imaging modalities (USG, CECT) in evaluation of N0 neck in head and neck squamous cell carcinoma. , 2012, Medical journal, Armed Forces India.

[13]  J. Werner,et al.  Delayed lymph node metastases after elective neck dissection in patients with oral and oropharyngeal cancer and pN0 neck. , 2012, American journal of otolaryngology.

[14]  M. Canis,et al.  Impact of elective neck dissection vs observation on regional recurrence and survival in cN0-staged patients with squamous cell carcinomas of the upper aerodigestive tract. , 2012, Archives of otolaryngology--head & neck surgery.

[15]  S. Stoeckli,et al.  Initial staging of the neck in head and neck squamous cell carcinoma: A comparison of CT, PET/CT, and ultrasound‐guided fine‐needle aspiration cytology , 2012, Head and Neck.

[16]  D. Schuller,et al.  The value of PET/CT to assess clinically negative necks , 2012, European Archives of Oto-Rhino-Laryngology.

[17]  T. Ohsako.  Sentinel lymph node biopsy for oral squamous cell carcinoma , 2012 .

[18]  J. Roodenburg,et al.  Performance of 18F-FDG PET/contrast-enhanced CT in the staging of squamous cell carcinoma of the oral cavity and oropharynx. , 2011, International journal of oral and maxillofacial surgery.

[19]  E. Sabo,et al.  Incidence of oral cancer occult metastasis and survival of T1-T2N0 oral cancer patients. , 2011, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[20]  Wade P Smith,et al.  Role of positron emission tomography in the treatment of occult disease in head-and-neck cancer: a modeling approach. , 2011, International journal of radiation oncology, biology, physics.

[21]  Xiao-dong Zhu,et al.  Accuracy of whole‐body PET and PET‐CT in initial M staging of head and neck cancer: A meta‐analysis , 2011, Head & neck.

[22]  Greg E. Davis,et al.  Effects of upstaging from PET scan on survival in head and neck squamous cell carcinoma , 2010, Head & neck.

[23]  Jonathan R. Clark,et al.  Role of pretreatment 18FDG‐PET/CT in surgical decision‐making for head and neck cancers , 2010, Head & neck.

[24]  R. Tishler,et al.  Cost-effectiveness of CT and PET-CT for determining the need for adjuvant neck dissection in locally advanced head and neck cancer. , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[25]  T. Watts,et al.  Identification of distant metastases with PET‐CT in patients with suspected recurrent head and neck cancer , 2009, The Laryngoscope.

[26]  P. Boscolo-Rizzo,et al.  Pattern of lymph node metastases in squamous cell carcinoma of the tonsil: implication for selective neck dissection. , 2009, Oral oncology.

[27]  M. Dietlein,et al.  Is There a Need for Positron Emission Tomography Imaging to Stage the N0 Neck in T1-T2 Squamous Cell Carcinoma of the Oral Cavity or Oropharynx? , 2008, The Annals of otology, rhinology, and laryngology.

[28]  J. Roodenburg,et al.  FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases. , 2008, Oral oncology.

[29]  D. Townsend,et al.  Positron emission tomography/computerized tomography (PET/CT) scanning for preoperative staging of patients with oral/head and neck cancer. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[30]  T. Beyer,et al.  TNM staging with FDG-PET/CT in patients with primary head and neck cancer , 2007, European Journal of Nuclear Medicine and Molecular Imaging.

[31]  J. Roodenburg,et al.  Value for confirmation of N 0 neck and detection of occult metastases , 2007 .

[32]  C. Timon,et al.  Evaluation of the impact of addition of PET to CT and MR scanning in the staging of patients with head and neck carcinomas , 2006, European Archives of Oto-Rhino-Laryngology and Head & Neck.

[33]  Y. Erdi,et al.  18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[34]  E. Choi,et al.  Management of Contralateral N0 Neck in Tonsillar Squamous Cell Carcinoma , 2005, The Laryngoscope.

[35]  P. Qiu.  The Statistical Evaluation of Medical Tests for Classification and Prediction , 2005 .

[36]  T. Yen,et al.  Staging of untreated squamous cell carcinoma of buccal mucosa with 18F-FDG PET: comparison with head and neck CT/MRI and histopathology. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[37]  H. Steinert,et al.  Staging of head and neck tumors: [18F]fluorodeoxyglucose positron emission tomography compared with physical examination and conventional imaging modalities. , 2003, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[38]  M. Pepe.  The Statistical Evaluation of Medical Tests for Classification and Prediction , 2003 .

[39]  R. Pellini,et al.  Elective treatment of the neck in squamous cell carcinoma of the larynx: Clinical experience , 2003, Head & neck.

[40]  C. Hollenbeak,et al.  The cost‐effectiveness of fluorodeoxyglucose 18‐F positron emission tomography in the N0 neck , 2001, Cancer.

[41]  D. Soutar,et al.  Improved survival for patients with clinically T1/T2, N0 tongue tumors undergoing a prophylactic neck dissection , 1999, Head & neck.

[42]  M. Persky,et al.  Treatment of the Clinically Negative Neck in Oral Squamous Cell Carcinoma , 1999, The Laryngoscope.

[43]  T. Loree,et al.  Patterns of nodal metastasis and surgical management of the neck in supraglottic laryngeal carcinoma , 1999, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[44]  J. Woolgar.  Pathology of the N0 neck. , 1999, The British journal of oral & maxillofacial surgery.

[45]  G. Tirelli,et al.  Predictive factors of nodal metastases in oral cavity and oropharynx carcinomas , 1999, The Laryngoscope.

[46]  G. Hör,et al.  Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer , 1998, European Journal of Nuclear Medicine.

[47]  M. Wax,et al.  Positron Emission Tomography in the Evaluation of the N0 Neck , 1998, The Laryngoscope.

[48]  H. Pillsbury,et al.  A Rationale for Therapy of the N0 Neck , 1997, The Laryngoscope.

[49]  W. Wei,et al.  Critical appraisal of watchful waiting policy in the management of N0 neck of advanced laryngeal carcinoma. , 1996, Archives of otolaryngology--head & neck surgery.

[50]  M Schwaiger,et al.  Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.