The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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Usefulness of $^{18}F-FDG$ PET/CT in the Diagnosis of Cervical Lymph Node Metastases of Head and Neck Cancer

두경부암 경부 림프절 전이의 진단에서 $^{18}F-FDG-PET/CT$의 유용성

  • Kim, Chung-Ho (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • Kim, Sung-Hoon (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • O, Joo-Hyun (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • Yoo, Ie-Ryung (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • Chung, Yong-An (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • Park, Young-Ha (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • Sohn, Hyung-Sun (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • Lee, Sung-Young (Department of Radiology, College of Medicine, Catholic University of Korea) ;
  • Chung, Soo-Kyo (Department of Radiology, College of Medicine, Catholic University of Korea)
  • 김정호 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 김성훈 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 오주현 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 유이령 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 정용안 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 박영하 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 손형선 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 이성용 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 정수교 (가톨릭대학교 의과대학 방사선과학교실)
  • Published : 2005.10.31
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Abstract

Purpose: This study evaluated the diagnostic value of $^{18}F-FDG$ PET/CT in detecting cervical lymph node metastases in head and neck cancer patients. Materials & Methods: The patients were divided into two groups, 46 patients underwent PET/CT scan for initial staging before surgery, and 20 patients for restaging of recurrence after primary treatment. Increased FDG uptakes in cervical lymph nodes were evaluated retrospectively and correlated with the histopathologic results. Results: In the initial staging group, 21 lymph nodes were detected by PET/CT in 15 patients. 20 lymph nodes were confirmed as metastases with a mean peak SUV of 5.84, and the remaining one lymph node was an inflammatory lesion, with a peak SUV of 2.75. Seven metastatic lymph nodes were reported only by histopatholoay. The sensitivity, specificity, positive predictive value and negative predictive value were 74.0%, 99.6%, 95.2% and 97.3%, respectively. In the recurrence group, 11 lymph nodes were detected in 9 patients, and 8 nodes were true positive, with a mean peak SUV of 5.65. The other three were inflammatous lymph nodes, and the peak SUVs were 2.16, 2.94 and 3.53. One false negative lymph node was reported. The sensitivity, specificity, positive predictive value and negative predictive value were 88.8%, 97.7%, 72.7% and 92.9%, respectively. Conclusions: FDG-PET/CT shows higher positive predictive value in the initial staging group, and better sensitivity in the recurrence group. Therefore PET/CT could be useful for both initial staging and restaging of recurrent cervical lymph node metastases.

목적: 두경부암 환자에서 경부림프절 전이의 진단에서의 $^{18}F-FDG$ PET/CT의 유용성을 알아보고자 하였다. 대상 및 방법: 환자들을 수술 전 병기 결정을 위해 PET/CT을 촬영한 환자 46명(수술 전 환자군, 남: 38명, 여: 8명, 평균나이: 54.54세)과 1차 치료 후 재발 병소의 병기 결정을 위해 PET/CT를 시행한 환자 20명(재발 환자군, 남: 15명, 여: 5명, 평균나이: 49.5세)의 두군으로 분류하였다. PET/CT에서 FDG 섭취를 보인 경부림프절을 병소 대 병소로 조직검사 소견과 후향적으로 비교하였다. 결과: 수술 전 환자 15명의 PET/CT에서 21개의 FDG 섭취 증가를 보이는 림프절이 관찰되었다. 이 중 20개가 조직학적으로 림프절 전이로 확진되었고 평균 최대 SUV는 5.84 (2.05-20.39)였다. 나머지 하나의 림프절은 조직 검사에서 염증성 병소로 진단되었고 최대 SUV는 2.75였다. 7개의 림프절전이가 조직검사에서만 발견되었다 민감도는 74.0%, 특이도는 99.6%, 양성 예측도는 95.2% 그리고 음성 예측도는 97.3%였다. 수술 후 환자 9명에서 11개의 림프절전이가 PET-CT에서 관찰되었고, 이 중 8개가 전이로 확진되었고 평균 최대 SUV는 5.65 (3.02-9.84)였다. 나머지 3개의 림프절들은 염증성 병소였고 평균 최대 SUV는 2.87였다. 1개의 위음성의 림프절이 발견되었다. 민감도는 88.8%, 특이도는 97.7%, 양성 예측도는 72.7% 그리고 음성 예측도는 92.9%였다. 결론: FDG-PET/CT은 두경부암 환자의 경부 림프절 전이를 평가하는데 수술 전 환자군에서는 보다 높은 양성 예측도를, 재발 환자군에서는 보다 높은 민감도를 보였다. 그러므로 PET/CT는 두경부암 환자에서 수술 전 환자와 재발 환자의 경부 림프절 전이의 진단에 유용하였다.

Keywords

References

  1. Ferlito A, Buckley JG, Shaha AR, Rinaldo A. Contemporary important considerations in diagnosis and treatment of head and neck cancer. Acta Otolaryngeol 2002;122:115-20 https://doi.org/10.1080/00016480252775841
  2. Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med 1993;328:184-94 https://doi.org/10.1056/NEJM199301213280306
  3. Sham JS, Choy D. Prognostic factors of nasopharyngeal carcinoma: a review of 759 patients. Br J Radiol 1990;63:51-8 https://doi.org/10.1259/0007-1285-63-745-51
  4. Whitehurst JO, Droulias CA. Surgical treatment of squamous cell carcinoma of the oral tongue. Arch Otolaryngol 1987;103:212-15
  5. Goodwin WJ Jr: Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: When do the ends justify the means? Laryngoscope 2000;110:1-18
  6. England RJ, Stafford ND. Conservative neck surgery in suamous cell carcinoma. Surg Oncol 1998;7;91-4 https://doi.org/10.1016/S0960-7404(99)00010-9
  7. England RJ, Stafford ND. Conservative neck surgery in suamous cell carcinoma. Surg Oncol 1998;7;91-4 https://doi.org/10.1016/S0960-7404(99)00010-9
  8. Albuquerque K, Cirrone J, Aziz H, Har-El G, Sundaram K, Dipillo F, et al. Quality of life with functional pharyngeal preservation in advanced carcinomas of the base tongue complex using an integreated trimodality approach. Am J Clin Oncol 2001;24:623-627 https://doi.org/10.1097/00000421-200112000-00020
  9. Adams S, Baum RP, Stuckensen T, Bitter K, Hor G. Prospective comparision of 18F-FDG PET with convential imaging modalities (CT, MRI, US) in Lymph node staging of head and neck cancer. Eur J Nucl Med 1998;25:1255-60 https://doi.org/10.1007/s002590050293
  10. Schder H, Yeung HWD. Positron emission imaging of head and neck cancer, including thyroid carcinoma. Semin Nucl Med 2004;34: 180-7 https://doi.org/10.1053/j.semnuclmed.2004.03.004
  11. Stokkel MP, ten Broek FW, Hordijk GJ, Koole R, Van Rijk PP. Preoperative evaluation of patients with primary head and neck cancer using dual head 18fluorodeoxyglucose positron emission tomography. Ann Surg 2000;231:229-234 https://doi.org/10.1097/00000658-200002000-00012
  12. Hanasono MM, Kunda LD, Segall GM, et al. Use and limitations of FDG positron emission tomography in patients with head and neck cancer. Laryngoscope 1999;109:880-5 https://doi.org/10.1097/00005537-199906000-00007
  13. Daisne JF, Sibomana M, Bol A, Cosnard G, Lonneux M, Gregoire V. Evaluation of a multimodality image (CT, MRI and PET) coregistration procedure on phantom and head and neck cancer patients: accuracy, reproducibility and consistaency. Radiother Oncol 2003;69:237-45 https://doi.org/10.1016/j.radonc.2003.10.009
  14. Schder H, Yeung HW, Gonen M, Kraus D, Larson SM. Head and neck cancer: Clinial usefulness and accuracy of PET/CT image fusion. Radiology 2004;231:65-72 https://doi.org/10.1148/radiol.2311030271
  15. Muylle K, Castaigne C, Flamen P. 18F-fluro-2-deoxy-D-glucose positron emission tomographic imaging: recent developments in head and neck cancer. Curr Opin Oncol 2005;17:249-53 https://doi.org/10.1097/01.cco.0000160276.78762.17
  16. Lowe VJ, Boyd JH, Dunphy FR, Kim H, Dunleavy T, Collins BT, et al. Surveillance for recurrent head and neck cancer using positron emissiontomography. J Clin Oncol 2000;18:651-8 https://doi.org/10.1200/JCO.2000.18.3.651
  17. Fischbein NJ, AAssar OS, Caputo GR, Kaplan MJ, Singer MI, Price DC, 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
  18. Wong RJ, Lin DT, Schder H, Patel SG, Gonen M, Wolden S, et al. Diagnostic and prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol. 2002 Oct 15;20(20):4199-208
  19. Kunkel M, Forster GJ, Reichert TE, Jeong JH, Benz P, Bartenstein P, et al. Detection of recurrent oral squamous cell carcinoma by [18F]-2-fluorodeoxyglucose-positron emission tomography: implications for prognosis and patients management. Cancer 2003;98:2257- 65 https://doi.org/10.1002/cncr.11763
  20. Corderio P: General principle of reconstructive surgery for head and neck cancer, in Harrison L, Sessions R, Hong W (eds): Head and Neck Cancer. A Multidisciplinary Approach. Philadelphia, Lippincott- Raven, 1999, p. 197-216