USEFULNESS OF $^{18}F$-FDG PET/CT IN THE EVALUATION OF CERVICAL LYMPH NODE METASTASIS IN PATIENTS WITH ORAL CANCER

구강암 환자에서 $^{18}F$ FDG-PET/CT의 경부 림프절 전이 평가 유용성

  • Yu, Min-Gi (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21) ;
  • Ryu, Sun-Youl (Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21)
  • 유민기 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21) ;
  • 유선열 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소, 2단계 BK21)
  • Published : 2009.08.31

Abstract

Purpose: The present study was aimed to examine the usefulness of 18F-FDG PET/CT in the evaluation of cervical lymph node metastasis in patients with oral cancer. Materials and methods: Twenty-two patients who underwent neck dissection to treat oral cancer were subjected for examination. The cervical node metastasis was evaluated by means of clinical examination, CT scan, PET, and histologic examination. By comparing the results of each examination modality with those of histologic examination, it's sensitivity, specificity, positive predictive value, and negative predictive value were determined. Results: The oral cancer was more frequent in males with a ratio of 2.14:1. The sixth decade showed the highest incidence in age distribution with mean of $56{\pm}16$. Histologic findings showed that squamous cell carcinoma was the most common (15 patients), and mucoepidermoid carcinoma (3), malignant melanoma (2), and adenoid cystic carcinoma and ghost cell odontogenic carcinoma (1 each), in order. In most cases, wide surgical excision of the primary cancer and neck dissection was performed, followed by reconstruction with free flaps when necessary. When comparing the results of each examination modality with those of the histologic examination, clinical examination showed sensitivity, specificity, positive predictive value, and negative predictive value at 11%, 85%, 33%, and 58%, respectively. CT scans showed at 67%, 77%, 67%, and 77%, while $^{18}F$-FDG PET/CT at 78%, 77%, 70%, and 83%, respectively. Conclusions: These results suggest that PET is more useful, compared with clinical examination and CT scans, in the evaluation of cervical lymph node metastasis in patients with oral cancer.

Keywords

References

  1. Adams S, Baum RP, Stuckensen T, Bitter K, Hor G. 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 https://doi.org/10.1007/s002590050293
  2. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics 2007. CA Cancer J Clin 2007;57:43-66 https://doi.org/10.3322/canjclin.57.1.43
  3. 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
  4. Ferlito A, Robbins KT, Shaha AR, Pellitteri PK, Kowalski LP, Gavilan J, et al. Current considerations in neck dissection. Acta Otolaryngol 2002;122:323-9 https://doi.org/10.1080/000164802753648259
  5. Ferlito A, Shaha AR, Rinaldo A. Evolution in the philosophy of neck dissection. Acta Otolaryngol 2001;121:963-6 https://doi.org/10.1080/00016480127366
  6. Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM. Head and neck cancer: Clinical usefulness and accuracy of PET/CT image fusion. Radiology 2004;231:65-72 https://doi.org/10.1148/radiol.2311030271
  7. Kapoor V, Fukui MB, McCook BM. Role of $^{18}F$ FDG PET/CT in the treatment of head and neck cancers: principles, technique, normal distribution, and initial staging. Am J Roentgenol 2005;184:579-87 https://doi.org/10.2214/ajr.184.2.01840579
  8. Van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 1990;177:379-84 https://doi.org/10.1148/radiology.177.2.2217772
  9. Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, et al. American Head and Neck Society; American Academy of Otolaryngology-Head and Neck Surgery. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 2002;128:751-8 https://doi.org/10.1001/archotol.128.7.751
  10. England RJ, Stafford ND. Conservative neck surgery in squamous cell carcinoma. Surg Oncol 1999;7:91-4 https://doi.org/10.1016/S0960-7404(99)00010-9
  11. Krabbe CA, Dijkstra PU, Pruim J, van der Laan BF, van der Wal JE, Gravendeel JP, et al. FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases. Oral oncol 2008;44: 31-6 https://doi.org/10.1016/j.oraloncology.2006.12.003
  12. Eichhorn T, Schroeder HG, Glanz H, Schwerk WB. Historically controlled comparison of palpation and sonography in the diagnosis of cervical lymph node metastases. Larygol Rhinol Otol 1987;66:266-74 https://doi.org/10.1055/s-2007-998651
  13. Van der Brekel MW, Castelijns JA, Snow GB. Imaging of cervical lymphadenopathy. Neuroimaging Clin N Am 1996;6:417-34
  14. Van den Brekel MW, van der Waal I, Meijer CJ, Freeman JL, Castelijns JA, Snow GB. The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections. Lyngoscope 1996;106:987-91 https://doi.org/10.1097/00005537-199608000-00014
  15. Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer 1990;66:109-13 https://doi.org/10.1002/1097-0142(19900701)66:1<109::AID-CNCR2820660120>3.0.CO;2-A
  16. Teichgraeber JF, Clairmont AA. The incidence of occult metastases for cancer of the oral tongue and floor of the mouth: treatment rationale. Head Neck Surg 1984;7:15-21 https://doi.org/10.1002/hed.2890070105
  17. Lee MC. Current status and future perspective of PET. Korean J Nucl Med 2002;36:1-7
  18. Macapinlac HA, Yeung HW, Larson SM. Defining the role of FDG PET in head and neck cancer. Clin Positron imaging 1999;2:311-6 https://doi.org/10.1016/S1095-0397(99)00033-3
  19. Conti PS, Lilien DL, Hawley K, Keppler J, Grafton ST, Banding JR. PET and [18F]-PDG in oncology: a clinical update. Nucl Med Biol 1996;23:717-35 https://doi.org/10.1016/0969-8051(96)00074-1
  20. Muylle K, Castaigne C, Flamen P. $^{18}F$-fluoro-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
  21. Schoder H, Yeung HW. Positron emission imaging of head and neck cancer, including thyroid carcinoma. Semin Nucl Med 2004;34:180-97 https://doi.org/10.1053/j.semnuclmed.2004.03.004
  22. Belhocine T, Spaepen K, Dusart M, Castaigne C, Muylle K, Bourgeois P, et al. 18FDG PET in oncology: The best and the wost. Int J Oncol 2006;28:1249-61
  23. Ahuja V, Coleman RE, Herndon J, Patz EF Jr. The prognostic significance of fluorodeoxyglucose positron tomography imaging for patients with nonsmall cell lung carcinoma. Cancer 1998;83:918-24 https://doi.org/10.1002/(SICI)1097-0142(19980901)83:5<918::AID-CNCR17>3.0.CO;2-Y
  24. Romer W, Hanauske AR, Ziegler S, Thodtmann R, Weber W, Fuchs C, et al. Positron emission tomography in non-Hodgkin's lymphoma: assessment of chemotherapy with fluorodeoxyglucose. Blood 1998;91:4464-71
  25. Vansteenkiste JF, Stroobants SG, Dupont PJ, De Leyn PR, Verbeken EK, Deneffe GJ, et al. Prognostic importance of the standardized uptake value on 18F-fluoro-2-deoxy-D-glucosepositron emission tomograpy scan in non-small-cell lung cancer: an analysis of 125 cases-Leuven Lung Cancer Group. J Clin Oncol 1999;17:3201-6 https://doi.org/10.1200/JCO.1999.17.10.3201
  26. Schoder H, Erdi YE, Chao K, Gonen M, Larson SM, Yeung HW. Clinical implications of different image reconstruction parameters for interpretation of whole-body PET studies in cancer patients. J Nucl Med 2004;45:559-66
  27. Nishimura T, Saji H, Iida H. The vast expanse of clinical PET for diagnostic imaging. Tokyo, Medical View Co. 2004:68-77
  28. Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med 2004;45:1431-4
  29. Thie JA, Hubner KF, Smith GT. The diagnostic utility of the lognormal behavior of PET standardized uptake values in tumors. J Nucl Med 2000;41:1664-72
  30. Leon X, Quer M, Diez S, Orus C, Lopez-pousa A, Burgues J. Second neoplasm in patients with head and neck cancer. Head Neck 1999;21:204-10 https://doi.org/10.1002/(SICI)1097-0347(199905)21:3<204::AID-HED4>3.0.CO;2-7
  31. Leon X, Ferlito A, Myer CM 3rd, Saffiotti U, Shaha AR, Bradley PJ, et al. Second primary tumors in head and neck patients. Acta Otolaryngol 2002;122:765-78 https://doi.org/10.1080/00016480252775788
  32. Hujala K, Sipila J, Grenman R. Panendoscopy and synchronous second primary tumors in head and neck cancer patients. Eur Arch Otorhinolaryngol 2005;262:17-20 https://doi.org/10.1007/s00405-004-0743-y
  33. Wax MK, Myers LL, Gabalski EC, Husain S, Gona JM, Nabi H. Positron emission tomography in the evaluation of synchronous lung lesions in patients with untreated head and neck cancer. Arch Otolarygol Head Neck Surg 2002;128:703-7 https://doi.org/10.1001/archotol.128.6.703
  34. Mukherji SK, Fischbein NJ, Castelijns JA. New imaging techniques. In: Som PM, Curtin HD, eds. Head and neck imaging, 4th ed. St. Louis, Mosby. 2003:2294-322
  35. Manolidis S, Donald PJ, Volk P, Pounds TR. The use of positron emission tomography scanning in occult and recurrent head and neck cancer. Acta Otolaryngol Suppl 1998;534:1-11 https://doi.org/10.1080/00016489850183629
  36. Dennington ML, Carter DR, Meyers AD. Distant metastases in head and neck epidermoid carcinoma. Laryngoscope 1980;90:196-201 https://doi.org/10.1288/00005537-198002000-00002
  37. Calhoun KH, Fulmer P, Weiss R, Hokanson JA. Distant metastases from head and neck squamous cell carcinomas. Laryngoscope 1994;104:1199-205 https://doi.org/10.1288/00005537-199410000-00003