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

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.

Keywords

¹⁸F-FDG positron emission tomography - recurrent head and neck cancer - metastases - standard uptake value

Schlüsselwörter

¹⁸F-FDG-Positronenemissionstomographie - Kopf-Hals-Tumor-Rezidiv - Metastasen - standard uptake value

• References

• 1 Aassar OS, Fischbein NJ, Caputo GR. et al. Metastatic head and neck cancer: role and usefulness of FDG PET in locating occult primary tumors. Radiology 1999; 210: 177-81.
• 2 Adams S, Baum RP, Stuckensen T. et al. Prospective comparison of ¹⁸F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 1998; 25: 1255-60.
• 3 Anzai Y, Carrooll WR, Quint DJ. et al. Recurrence of head and neck cancer after surgery or irradiation: Prospective comparison of 2-deoxy-2-(F-18)fluoro-D-glucose PET and MR imaging diagnosis. Radiology 1996; 200: 135-41.
• 4 Bailet JW, Sercarz JA, Abemayor E. et al. The use of positron emission tomography for early detection of recurrent head and neck squamous cell carcinoma in postradiotherapy patients. Laryngoscope 1995; 105: 135-9.
• 5 Bender H, Straehler-Pohl HJ. Kopf-HalsTumoren. In: Wieler HJ. (ed). PET in der klinischen Onkologie. Darmstadt: Steinkopff; 1999: 133-47.
• 6 Brink I, Klenzner Th, Krause Th. et al. Lymph node staging in extracranial head and neck cancer with FDG PET – appropriate uptake period and size-dependence of the results. Nuklearmedizin 2002; 41: 108-13.
• 7 Bronstein AD, Nyberg DA, Schwartz AN. et al. Soft-tissue changes after head and neck radiation: CT findings. Am J Neuroradiol 1989; 10: 171-5.
• 8 Brun E, Kjellén E, Tennvall J. et al. FDG PET studies during treatment: prediction of therapy outcome in head and neck squamous cell carcinoma. Head Neck 2002; 24: 127-35.
• 9 Canto MT, Devesa SS. Oral cavity and pharynx cancer incidence rates in the United States, 1975 – 1998. Oral Oncol 2002; 38: 610-7.
• 10 Changlai SP, Kao CH, Chieng PU. ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography of head and neck in patients with nasopharyngeal carcinomas. Oncol Rep 1997; 4: 1331-4.
• 11 Dresel S, Schwenzer K, Brinkbäumer K. et al. (F-18)FDG imaging of head and neck tumors: comparison of hybrid PET, dedicated PET and CT. Nuklearmedizin 2001; 40: 172-8.
• 12 Eichhorn T, Schroeder HG, Glanz H. et al. Histologically controlled comparison of palpation and sonography in the diagnosis of cervical lymph node metastases. Laryngol Rhinol Otol 1987; 66: 266-74.
• 13 Farber LA, Benard F, Machtay M. et al. Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2-¹⁸Ffluoro-2-deoxy-D-glucose positron emission tomography. Laryngoscope 1999; 109: 970-5.
• 14 Fischbein NJ, Aassar OS, Caputo GR. et al. Clinical utility of positron emission tomography with ¹⁸F-fluorodeoxyglucose in detecting residual / recurrent squamous cell carcinoma of the head and neck. Am J Neuroradiol 1998; 19: 1189-96.
• 15 Forastiere A, Koch W, Trotti A. et al. Head and neck cancer. N Engl J Med 2001; 345: 1890-900.
• 16 Glazer HS, Niemeyer JH, Balfe DM. et al. Neck neoplasms: MR imaging. Part I. Initial evaluation. Radiology 1986; 160: 343-8.
• 17 Glazer HS, Niemeyer JH, Balfe DM. et al. Neck neoplasms: MR imaging. Part II. Posttreatment evaluation. Radiology 1986; 160: 349-54.
• 18 Graham MM, Peterson LM, Hayward RM. Comparison of simplified quantitative analyses of FDG uptake. Nucl Med Biol 2000; 27: 647-55.
• 19 Greven KM, Williams III DW, Keyes Jr JW. et al. Can positron emission tomography distinguish tumor recurrence from irradiation sequelae in patients treated for larynx cancer?. Cancer J Sci Am 1997; 3: 353-7.
• 20 Greven KM, Williams III DW, Keyes Jr JW. et al. Positron emission tomography of patients with head and neck carcinoma before and after high dose irradiation. Cancer 1994; 74: 1355-9.
• 21 Haberkorn U, Strauss LG, Reisser C. et al. Positron emission tomography (PET) for the evaluation of tumor proliferation and for therapy monitoring in head and neck tumors. Radiologe 1992; 32: 296-301.
• 22 Hamacher K, Coenen HH, Stoecklin G. Efficient stereospecific synthesis of no-carrier-added 2-(18F)-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986; 27: 235-8.
• 23 Hawkins RA, Choi Y, Huang SC. et al. Quantitating tumor glucose metabolism with FDG and PET. J Nucl Med 1992; 33: 339-44.
• 24 Huang SC. Anatomy of SUV. Standardized uptake value. Nucl Med Biol 2000; 27: 643-6.
• 25 Johnson JT, Myers EN, Bedetti CD. et al. Cervical lymph node metastases: incidence and implications of extracapsular carcinoma. Arch Otolaryngol 1985; 111: 534-7.
• 26 Jungehuelsing M, Scheidhauer K, Damm M. et al. 2(¹⁸F)-fluoro-2-deoxy-D-glucose positron emission tomography is a sensitive tool for the detection of occult primary cancer (carcinoma of unknown primary syndrome) with head and neck lymph node manifestation. Otolaryngol Head Neck Surg 2000; 123: 294-301.
• 27 Kao CH, Changlai SP, Chieng PU. et al. Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with 18-fluoro-2-deoxyglucose positron emission tomography and comparison with computed tomography. J Clin Oncol 1998; 16: 3550-5.
• 28 Keyes Jr JW. SUV: standard uptake or silly useless value?. J Nucl Med 1995; 36: 1836-9.
• 29 Keyes Jr JW, Harkness BA, Greven KM. et al. Salivary gland tumors: pretherapy evaluation with PET. Radiology 1994; 192: 99-102.
• 30 Kitagawa Y, Sadato N, Azuma H. et al. FDG PET to evaluate combined intra-arterial chemotherapy and radiotherapy of head and neck neoplasms. J Nucl Med 1999; 40: 1132-7.
• 31 Lapela M, Eigtved A, Jyrkkio S. et al. Experience in qualitative and quantitative FDG PET in follow-up of patients with suspected recurrence from head and neck cancer. Eur J Cancer 2000; 36: 858-67.
• 32 Lapela M, Grénman R, Kurki T. et al. Head and neck cancer: Detection of recurrence with PET and 2-(F-18)fluoro-2-deoxy-D-glucose. Radiology 1995; 197: 205-11.
• 33 Laubenbacher C, Kau RJ, Alexiou C. et al. Kopf-Hals-Tumoren. In: Ruhlmann J, Oehr P, Biersack HJ. (Hrsg). PET in der Onkologie. Berlin, Heidelberg: Springer; 1998: 64-77.
• 34 Laubenbacher C, Saumweber D, Wagner-Manslau C. et al. Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med 1995; 36: 1747-57.
• 35 Lowe VJ, Boyd JH, Dunphy FR. et al. Surveil-lance for recurrent head and neck cancer using positron emission tomography. J Clin Oncol 2000; 18: 651-8.
• 36 Lowe VJ, Dunphy FR, Varvares M. et al. Evaluation of chemotherapy response in patients with advanced head and neck cancer using (F-18)fluorodeoxyglucose positron emission tomography. Head Neck 1997; 19: 666-74.
• 37 Manolidis S, Donald PJ, Volk P. et al. The use of positron emission tomography scanning in occult and recurrent head and neck cancer. Acta Otolaryngol 1998; 534 Suppl 5-11.
• 38 McGuirt WF, Williams III DW, Keyes Jr JW. et al. A comparative diagnostic study of head and neck nodal metastases using positron emission tomography. Laryngoscope 1995; 105: 373-5.
• 39 Menda Y, Bushnell DL, Madsen MT. et al. Evaluation of various corrections to the standardized uptake value for diagnosis of pulmonary malignancy. Nucl Med Commun 2001; 22: 1077-81.
• 40 Minn H, Joensuu H, Ahonen A. et al. Fluorodeoxyglucose imaging: a method to assess the proliferative activity of human cancer in vivo. Cancer 1988; 61: 1776-81.
• 41 Myers E, Leffall L. Head and neck oncology: diagnosis, treatment and rehabilitation. Boston: Little Brown; 1991
• 42 Nowak B, Di Martino E, Jänicke S. et al. Diagnostic evaluation of malignant head and neck cancer by F-18-FDG PET compared to CT/ MRI. Nuklearmedizin 1999; 38: 312-8.
• 43 Pöpperl G, Lang S, Dagdelen O. et al. Correlation of FDG-PET and MRI/CT with histo-pathology in primary diagnosis, lymph node staging and diagnosis of recurrency of head and neck cancer. Fortschr Röntgenstr 2002; 174: 714-20.
• 44 Ramos CD, Erdi YE, Gonen M. et al. FDG-PET standardized uptake values in normal anatomical structures using iterative reconstruction segmented attenuation correction and filtered back-projection. Eur J Nucl Med 2001; 28: 155-64.
• 45 Rege SD, Chaiken L, Hoh CK. et al. Change induced by radiation therapy in FDG uptake in normal and malignant structures of the head and neck: quantitation with PET. Radiology 1993; 189: 807-12.
• 46 Rege SD, Maass A, Chaiken L. et al. Use of positron emission tomography with fluorodeoxyglucose in patients with extracranial head and neck cancers. Cancer 1994; 73: 3047-58.
• 47 Reske SN, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German interdisciplinary consensus conference, “Onko-PET III”, 21 July and 19 September 2000. Eur J Nucl Med 2001; 28: 1707-23.
• 48 Ribeiro KCB, Kowalski LP, Latorre MRDO. Impact of comorbidity, symptoms, and patients’ characteristics on the prognosis of oral carcinomas. Arch Otolaryngol Head Neck Surg 2000; 126: 1079-85.
• 49 Seifert E, Schadel A, Haberkorn U. et al. Use of positron emission tomography to evaluate the effectiveness of chemotherapy in patients with head and neck cancer. HNO 1992; 40: 90-3.
• 50 Slevin NJ, Collins CD, Hastings DL. et al. The diagnostic value of positron emission tomography (PET) with radiolabelled fluorodeoxyglucose (¹⁸F-FDG) in head and neck cancer. J Laryngol Otol 1999; 113: 548-54.
• 51 Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. Am J Roentgenol 1992; 158: 961-9.
• 52 Stokkel MP, ten Broek FW, Hordijk GJ. et al. Preoperative evaluation of patients with primary head and neck cancer using dual-head 18fluorodeoxyglucose positron emission tomography. Ann Surg 2000; 231: 229-34.
• 53 Sugawara Y, Zasadny KR, Neuhoff AW. et al. Reevaluation of the standardized uptake value for FDG: variations with body weight and methods for correction. Radiology 1999; 213: 521-5.
• 54 Wienhard K, Eriksson L, Grootoonk S. et al. Performance evaluation of the positron scanner ECAT EXACT. J Comput Assist Tomogr 1992; 16: 804-13.
• 55 Wong RJ, Lin DT, Schöder H. et al. Diagnostic and prognostic value of (¹⁸F)fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol 2002; 20: 4199-208.
• 56 Young H, Baum R, Cremerius U. et al on behalf of the European organization for research and treatment of cancer (EORTC) PET study group.. Measurement of clinical and subclinical tumour response using (¹⁸F)-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. Eur J Cancer 1999; 35: 1773-83.
• 57 Zimny M, Wildberger JE, Cremerius U. et al. Combined image interpretation of computed tomography and hybrid PET in head and neck cancer. Nuklearmedizin 2002; 41: 14-21.