To Assess the Clinical Impact of 18F-FDG PET/CT in Non-Treated Cases of Squamous Cell Carcinoma of Head and Neck Presenting with Clinically and/or Radiologically N0 Status
Background: The most common sites are the oral cavity, pharynx and larynx and 85% to 95% neoplasms of the head and neck are SCCHN. The preservation of function, especially as it relates to speech, swallowing, and mastication, as well as cosmetic considerations, are considered essentials for determining the most effective management paradigm for SCCHN. The most common known imaging modalities in clinical use are CT and MRI imaging, despite their suboptimal sensitivity and specificity for the detection of distant metastases. The aim of present study is to establish the impact of 18F-FDG PET/CT in clinically and/or radiologically negative neck in the assessment of cervical lymph nodes. Materials & Methods: The present study was conducted in the Department of Nuclear Medicine and PET CT, Sudhamayi Hospitals and Clinics, Cochin, Kerala over a period of about one and half years. The study group comprised of untreated patients of both sexes with age ranging from 20 to 81 years referred to our department with an established tissue diagnosis of SCCHN for 18F-FDG-PET/CT Whole Body scan for evaluation of disease status and staging. 8 -10 mCi of 18F-Flouro-Deoxy-Glucose (18F-FDG) was injected I.V. in euglycemic status. Time of injection was noted along with pre-injection and post injection counts. Whole body PET/CT images (head to mid-thigh) were acquired after 45 min to 60 min post injection. Data including age, sex, endoscopy (direct / indirect) findings, neck lymph nodes level by clinical examination and radiological finding, FNAC/histopathology report of the primary and /or lymph nodes and conventional imaging (CT/MRI when available) findings was recorded. SPSS software was used for analysis. Results: At presentation, in 32.4% (n-12) of patients no nodes were palpable. Ipsilateral (single / multiple levels) lymph nodes were present in 48.7% of the patients (n-18). Bilateral involvement was seen in 18.9% (n-7) of the cases. Patient with FDG non avid necrotic lymph node was staged N0 on PET/CT but clinically had N2c disease was excluded from further analysis. There was no change in the overall stage or management of this patient. Conclusion: 18F-FDG PET/CT can accurately predict N stage better than clinical / conventional imaging leading to change in nodal staging and thus overall staging of patients. Thus it acts as a valuable tool in determining the exact nodal spread of squamous cell carcinoma and thus establishing the exact treatment plan.
2. Blot WJ, McLaughlin JK, Winn DM et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988; 48: 3282-87
3. Vineis P, Aavanja M, Buffler P et al. Tobacco and cancer: recent epidemiological evidence. J Natl Cancer Inst 2004; 96: 99-106
4. Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet 2008; 371: 1695-709
5. Lale Kostakoglu. Chapter 45 PET/CT Imaging. Head and Neck Imaging, Fifth Edition. Peter M. Som and Hugh D. Curtin
6. de Bree R, Haigentz M Jr, Silver CE, et al. Oral Oncol 2012; 48 (9): 780- 786
7. Madison MT, Remley KB, Latchaw RE, et al. Radiological diagnosis: Staging of head and neck squamous cell carcinoma. Radiol Clin North Am 1994; 32: 163-181
8. Snow GB, Annyas AA, van Slooten EA, et al. Prognostic factors of neck node metastases. Clin Otolaryngol 1982; 7: 185-192
9. Duvvuri U, Simental AA Jr, D’Angelo G,, et al. Elective neck dissection and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx. Laryngoscope 2004; 114: 2228-2234
10. Schroeder U, Dietlein M, Wittekindt C, et al. Is there a need for positron emission tomography imaging to stage the N0 neck in T1-T2, squamous cell carcinoma of the oral cavity or oropharynx? Ann Oto Rhinol Laryngol 2008; 117: 854-863
11. Cheng A, Schmidt BL. Management of the N0 neck in oral squamous cell carcinoma. Oral Maxillofac Surg Clin North Am 2008; 20; 477-497
12. Laubenbacher C, Saumweber D, Wagner-Manslau C, et al. Comparison of 18F-FDG-PET, MRI and endoscopy for staging head and neck squamous cell carcinomas. J Nucl Med 1995; 36: 1747-1757
13. Wong WL, Chevertton E, McGurk M, et al. A prospective study of PET-FDG imaging for the assessment of head and neck squamous cell carcinoma. Clin Otolaryngol 1997; 22: 209-214
14. Kim MR, Roh JL, Kim JS, et al. 18F-FDG-PET and bone scintigraphy for detection of metastases in patients with malignancies of the upper aerodigestive tract. Oral Oncol 2008; 44: 148-15.
15. Hannah A, Scott AM, Tochon-Danguy H, et al. Evaluation of 18F-FDG PET/CT with histopathological correlation in the initial staging of head and neck cancer. Ann Surg 2002; 236: 208-217
16. Adam 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: 1255-1260
17. Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2004. Bethesda, MD: National Cancer Institute, 2006
18. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108
19. Layland MK, Sessions DG, Lenox J. The influence of lymph node metastases in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx: N0 versus N+. Laryngoscope 2005; 115: 629-639
20. Prestwich RJ, Bhatnagar P, Chowdhury FU, et al. The impact of 18F-FDG PET CT prior to chemoradiotherapy for stage III/IV head and neck squamous cell carcinoma. ISRN Ocol 2012;2012:636379. doi: 10.5402/2012/636379. Epub 2012 Mar 24.
21. Jereczek-Fossa BA, Jassem J, Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev 2004; 30: 153-64
22. Yamazaki Y, Saitoh M, Notani K, et al. Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer. Ann Nucl Med 2008; 22: 177-184
23. Hafidh MA, Lacy PD, Hughes JP, et al. Evaluation of the impact of addition of PET to CT and MR scanning in the staging of patients with head and neck carcinomas. Eur Arch Otorhinolaryngol 2006; 263: 853-859
24. Krabbe CA, Dijkstra PU, Pruim J, et al. FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases. Orol Oncol 2008; 44: 31-36
25. Jeong HS, Baek CH, Son YI, et al. Use of integrated 18F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma. Head Neck 2007; 29: 203-210.
Copyright (c) 2018 International Archives of BioMedical and Clinical Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.