¹⁸F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases

 

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Summary

Aim: Assessment of the clinical value of ¹⁸F-FDG-PET for detection of recurrent head and neck cancer, local lymph node involvement and distant metastases comparing a qualitative visual with a semiquantitative analysis (SUV values). Patients, methods: Retrospective evaluation of 73 ¹⁸F-FDG PET studies in 55 patients by use of a four-step qualitative visual grading system and calculation of standard uptake values in pathological lesions. Calculation of SUV values in normal regions for generating a map of physiological ¹⁸F-FDG distribution. Correlation to histopathological findings and clinical follow-up. Results: 1. Qualitative visual analysis of ¹⁸F-FDG PET studies: a) local recurrence sensitivity 79%, specificity 97%, positive predictive value 95%, negative predictive value 85%, and diagnostic accuracy 89%; b) local metastatic lymph nodes 100%, 95%, 85%, 100%, 96%; c) distant metastases 100%, 98%, 86%, 100%, 98%, respectively. 2. Semiquantitative analysis had only little incremental, non-significant value in comparison to qualitative visual analysis for the detection of a local recurrence in two patients: a) local recurrence: sensitivity 83%, specificity 100%, positive predictive value 100%, negative predictive value 88%, and diagnostic accuracy 93%; b) local metastatic lymph nodes or c) distant metastases did not change in comparison to qualitative visual analysis. Conclusion: ¹⁸F-FDG PET is an effective tool for re-staging of patients with suspected recurrence after therapy for head and neck cancer.

Zusammenfassung

Ziel: Untersuchung zum klinischen Wert der ¹⁸F-FDGPET zum Nachweis eines Lokalrezidivs, lokoregionärer Lymphknoten- und Fernmetastasen bei Patienten mit Kopf-Hals-Tumoren und Rezidivverdacht. Vergleich einer qualitativ-visuellen mit einer semiquantitativen (SUVWerte) Bildauswertung. Patienten und Methoden: Retrospektive Beurteilung von 73 ¹⁸F-FDG-PET-Untersuchungen bei 55 Patienten mittels vierstufiger visuellqualitativer Bewertungsskala und über Bestimmung von SUV-Werten in pathologischen Herdbefunden. Bestim-mung von SUV-Werten in normalen Regionen zur Erstel-lung einer Karte physiologischer ¹⁸F-FDG-Anreicherung. Korrelation zu histopathologischen Befunden und klinischen Verläufen. Ergebnisse: 1. Qualitativ-visuelle Auswertung der ¹⁸F-FDG-PET-Untersuchungen: a) Lokalrezidiv: Sensitivität 79%, Spezifität 97%, positiver prädiktiver Wert 95%, negativer prädiktiver Wert 85% und diagnostische Genauigkeit 89%; b) lokoregionäre Lymphknotenmetastasen: 100%, 95%, 85%, 100%, 96%; c) Fernmetastasen: 100%, 98%, 86%, 100%, 98%. 2. Die semiquantitative Analyse erbrachte nur einen geringen inkrementalen, nicht signifikanten Nutzen im Vergleich zur qualitativ-visuellen Bildauswertung bei zwei Patienten in der Detektion des Lokalrezidivs: a) Lokalrezidiv: Sensitivität 83%, Spezifität 100%, positiver prädiktiver Wert 100%, negativer prädiktiver Wert 88% und diagnostische Genauigkeit 93%; b) lokoregionäre Lymphknoten- oder c) Fernmetastasen ohne Befundänderung im Vergleich zur qualitativ-visuellen Auswertung. Schlussfolgerung: ¹⁸F-FDG-PET ist ein effektives Verfahren zum Re-Staging von Patienten mit behandelten Kopf-Hals-Tumoren und Rezidivverdacht.

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