The utility of FDG-PET for detecting multiple primary cancers in hypopharyngeal cancer patients

Summary

Aim: To examine the utility of 2’-[¹⁸F]-fluoro-2’-deoxy-D-glucose positron emission tomography (FDG-PET) for detecting multiple primary cancers (MPC) in patients with hypopharyngeal cancer (HPC). Patients, methods: Seventy patients with HPC underwent FDG-PET to determine the staging. Routine clinical examinations were carried out, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), and oesophagealgastroduodenoscopy (EGDS). The detection rate of synchronous and metachronous cancer was calculated based on FDG-PET alone or FDG-PET combined with clinical routine examination. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and accuracy were used to diagnose oesophageal cancer using FDG-PET. Results: Of the 70 patients, 12 (17.1%) had 15 synchronous tumours, and 2 of the 58 remaining patients (3.4%) had metachronous tumours. Oesophageal cancer was discovered most frequently: superficial type (n=6), advanced type (n=4). On a per-patient basis, 11 of 12 patients (91.6%) were diagnosed with synchronous tumours, and on a per-lesion basis, 12 of 15 lesions (80.0%) were detected by FDG-PET.The sensitivity, specificity, accuracy, PPV, and NPV of FDG-PET regarding oesophageal cancer were 70%, 100%, 95.7%, 100%, and 95.2% respectively. Three of the six superficial types were positive on FDG-PET. Both of the metachronous tumour lesions were detected by FDG-PET. Conclusion: FDG-PET is useful for estimating the MPC in HPC patients. Since 3 of 10 synchronous oesophageal cancer were missed with PET alone, a combination with EGDS should be considered to exclude synchronous oesophageal cancer.

Zusammenfassung

Ziel: Untersucht wird, ob die 2’-[¹⁸F]-Fluor-2’-desoxy-D-glukose-Positronenemissionstomografie (FDG-PET) zur Aufdeckung multipler Primärtumore (MPT) bei Patienten mit Hypopharynxtumoren (HPT) geeignet ist. Patienten, Methoden: 70 HPT-Patienten unterzogen sich einer FDG-PET zum Staging. Weitere Routineuntersuchungen waren u.a. Computertomografie (CT), Magnetresonanztomografie (MRT), Ultraschall (US) und Ösophagogastro-Duodenoskopie (ÖGD). Die Aufdeckungsrate synchroner und metachroner Tumore wurde auf Grundlage von FDG-PET alleine oder FDG-PET kombiniert mit Routineuntersuchungen berechnet. Zur Diagnose eines Ösaphagus-Malignoms mittels FDG-PET wurden analysiert: Sensitivität, Spezifität, positiver und negativer Vorhersagewert (PPV, NPV) sowie Treffgenauigkeit. Ergebnisse: Von den 70 Patienten wiesen 12 (17,1%) 15 synchrone Tumore auf, 2 der übrigen 58 Patienten (3,4%) hatten metachrone Tumore. Ösophagus-Malignome wurden am häufigsten entdeckt: oberflächliche (n=6) und fortgeschrittene Typen (n=4). Bezogen auf Patienten wurden bei 11 von 12 Patienten (91,6%) synchrone Tumore diagnostiziert; bezogen auf Läsionen wurden 12 von 15 Läsionen (80,0%) durch FDG-PET aufgedeckt. Sensitivität, Spezifität, Treffgenauigkeit, PPV und NPV der FDG-PET hinsichtlich Ösophagus-Malignomen waren 70%, 100%, 95,7%, 100% bzw. 95,2%. Drei der sechs oberflächlichen Läsionen waren positiv im FDG-PET. Beide metachronen Tumore wurden durch FDG-PET aufgedeckt. Schlussfolgerung: FDG-PET ist zur Beurteilung von MPT bei HPT-Patienten geeignet. Da 3 von 10 synchronen Ösophagus-Malignomen durch PET alleine übersehen wurden, sollte PET mit ÖGD kombiniert werden, um synchrone Ösophagus-Malignome auszuschließen.

Keywords

Hypopharyngeal cancer - FDG-PET - multiple primary cancer - oesophageal cancer

Schlüsselwörter

Hypopharynx-Malignom - FDG-PET - multiple Primärtumore - Ösophagus-Malignom

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