Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck.

PURPOSE To assess the clinical usefulness of [(18)F]fluorodeoxyglucose positron emission tomography ([18F]FDG PET) as well as computed tomography (CT) or magnetic resonance imaging (MRI) in oral squamous cell carcinoma (SCC) patients with palpably negative neck. PATIENTS AND METHODS In total, 134 oral SCC patients with palpably negative neck were prospectively evaluated with [18F]FDG PET, CT/MRI, and their visual correlation. Histopathologic analysis was used as the gold standard for assessment of these imaging techniques. RESULTS Thirty-five (26.1%) of our 134 patients were found to have neck metastases. On a level-by-level basis, the sensitivity of [18F]FDG PET for nodal metastases was two-fold higher than that of CT/MRI (41.2% v 21.6%, respectively; P = .021). Visual correlation of [(18)F]FDG PET and CT/MRI yielded slightly higher sensitivity and specificity than [18F]FDG PET alone (47.1% v 41.2%, P = .25; 98.0% v 96.8%, P = .125, respectively). On a patient-by-patient basis, the sensitivity of [18F]FDG PET for neck metastases was 51.4% and increased to 57.1% after visual correlation with CT/MRI. The probabilities of occult neck metastasis after using [(18)F]FDG PET were 6.7% in T1 tumors, 10.8% in T2 tumors, 13.3% in T3 tumors, and 25% in T4 tumors and decreased to 3.3% in T1 tumors and to 9.2% in T2 tumors after visual correlation with CT/MRI. CONCLUSION [(18)F]FDG PET was superior to CT/MRI for detecting palpably occult neck metastasis of oral SCC. Because [(18)F]FDG PET could reduce the probability of occult neck metastasis to less than 15% in T1 to T3 tumors, it should be indicated for evaluation of these subpopulations.

[1]  B. Beuthien-Baumann,et al.  FDG-PET in the pretherapeutic evaluation of primary squamous cell carcinoma of the oral cavity and the involvement of cervical lymph nodes. , 2002, Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging.

[2]  J L Roodenburg,et al.  Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MRI. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[3]  T. Yen,et al.  T4b oral cavity cancer below the mandibular notch is resectable with a favorable outcome. , 2007, Oral oncology.

[4]  Chung-Jan Kang,et al.  Treatment outcome of combined modalities for buccal cancers: unilateral or bilateral neck radiation? , 2008, International journal of radiation oncology, biology, physics.

[5]  Ho-Fai Wong,et al.  18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[6]  C. Silver,et al.  Computed tomography of the clinically negative neck , 1990 .

[7]  G. Snow,et al.  Detection of lymph node metastases in the neck: radiologic criteria. , 1994, Radiology.

[8]  J. Freeman,et al.  MRI and neck metastases: a clinical, radiological, pathological correlative study. , 1990, The Journal of otolaryngology.

[9]  H. Curtin,et al.  Imaging-based nodal classification for evaluation of neck metastatic adenopathy. , 2000, AJR. American journal of roentgenology.

[10]  J. Freeman,et al.  Metastatic neck disease. A clinical/radiographic/pathologic correlative study. , 1987, Archives of otolaryngology--head & neck surgery.

[11]  P. V. van Rijk,et al.  Preoperative evaluation of patients with primary head and neck cancer using dual-head 18fluorodeoxyglucose positron emission tomography. , 2000, Annals of surgery.

[12]  T. Yen,et al.  Salvage therapy in relapsed squamous cell carcinoma of the oral cavity: How and when? , 2008, Cancer.

[13]  B. Pacella,et al.  Rationale for elective neck dissection in 1990 , 1990, The Laryngoscope.

[14]  T. Yen,et al.  Good tumor control and survivals of squamous cell carcinoma of buccal mucosa treated with radical surgery with or without neck dissection in Taiwan. , 2006, Oral oncology.

[15]  T. Yen,et al.  Does adjuvant radiation therapy improve outcomes in pT1-3N0 oral cavity cancer with tumor-free margins and perineural invasion? , 2008, International journal of radiation oncology, biology, physics.

[16]  T. Yen,et al.  Survival in squamous cell carcinoma of the oral cavity , 2007, Cancer.

[17]  T. Yen,et al.  Analysis of risk factors for distant metastases in squamous cell carcinoma of the oral cavity , 2007, Cancer.

[18]  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.

[19]  C. Metz.  ROC Methodology in Radiologic Imaging , 1986, Investigative radiology.

[20]  O. Hoekstra,et al.  Positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior? , 2004, European Archives of Oto-Rhino-Laryngology and Head & Neck.

[21]  W N Hanafee,et al.  Extracranial head and neck: PET imaging with 2-[F-18]fluoro-2-deoxy-D-glucose and MR imaging correlation. , 1993, Radiology.

[22]  H. Baddeley,et al.  A prospective study of PET-FDG imaging for the assessment of head and neck squamous cell carcinoma. , 1997, Clinical otolaryngology and allied sciences.

[23]  M. Wax,et al.  Positron emission tomography in the evaluation of the negative neck in patients with oral cavity cancer , 1998 .

[24]  T. Yen,et al.  Negative Impact of 18F-FDG PET for Restaging in a Case of Recurrent Buccal Cancer , 2006 .

[25]  Li‐yu Lee,et al.  Surgical treatment and prognostic analysis for gastrointestinal stromal tumors (GISTs) of the small intestine: before the era of imatinib mesylate , 2006, BMC gastroenterology.

[26]  L. Harrison,et al.  Use of decision analysis in planning a management strategy for the stage N0 neck. , 1994, Archives of otolaryngology--head & neck surgery.

[27]  S. Stoeckli,et al.  Is there a role for positron emission tomography with 18F‐fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma , 2002, Head & neck.

[28]  F. Maes,et al.  FDG-PET scan in potentially operable non-small cell lung cancer: do anatometabolic PET-CT fusion images improve the localisation of regional lymph node metastases? , 1998, European Journal of Nuclear Medicine.

[29]  Li‐yu Lee,et al.  Expression of matrix metalloproteinases MMP-2 and MMP-9 in gastric cancer and their relation to claudin-4 expression. , 2008, Histology and histopathology.

[30]  G. Snow,et al.  Management of cervical lymph nodes in patients with head and neck cancer , 2004, European Archives of Oto-Rhino-Laryngology.

[31]  F. Civantos,et al.  Sentinel node biopsy in oral cavity cancer: Correlation with PET scan and immunohistochemistry , 2003, Head & neck.

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

[33]  W. Waddington,et al.  A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography. , 2003, Oral oncology.

[34]  P. Levine,et al.  Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. , 2002, Archives of otolaryngology--head & neck surgery.

[35]  Li‐yu Lee,et al.  Identification of differential gene expression between intestinal and diffuse gastric cancer using cDNA microarray. , 2006, Oncology reports.

[36]  Li‐yu Lee,et al.  DSG3 is overexpressed in head neck cancer and is a potential molecular target for inhibition of oncogenesis , 2007, Oncogene.

[37]  M. Schwaiger,et al.  Lymph node detection of head and neck squamous cell carcinomas by positron emission tomography with fluorodeoxyglucose F 18 in a routine clinical setting. , 1999, Archives of otolaryngology--head & neck surgery.

[38]  T. Yen,et al.  Analysis of Risk Factors of Predictive Local Tumor Control in Oral Cavity Cancer , 2008, Annals of Surgical Oncology.

[39]  Hung-Ming Wang,et al.  Differentially expressed genes in radioresistant nasopharyngeal cancer cells : gp 96 and GDF 15 , 2007 .

[40]  Yu-Chen Chang,et al.  Nodal metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[41]  Li‐yu Lee,et al.  Differential expression of claudin-4 between intestinal and diffuse-type gastric cancer. , 2006, Oncology reports.

[42]  S. Ng,et al.  Magnetic Resonance Imaging versus Clinical Palpation in Evaluating Cervical Metastasis from Head and Neck Cancer , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[43]  J Valk,et al.  Cervical lymph node metastasis: assessment of radiologic criteria. , 1990, Radiology.

[44]  K. Pitman.  Rationale for elective neck dissection. , 2000, American journal of otolaryngology.

[45]  Li‐yu Lee,et al.  Long-term changes in trace elements in patients undergoing chronic hemodialysis , 2006, Biological Trace Element Research.

[46]  T. Yen,et al.  Survival of second and multiple primary tumors in patients with oral cavity squamous cell carcinoma in the betel quid chewing area. , 2007, Oral oncology.

[47]  D. Slosman,et al.  The role of FDG-PET in the preoperative assessment of N-staging in head and neck cancer. , 1996, Acta oto-laryngologica.