Utility of Positron Emission Tomography-Computed Tomography in Identification of Residual Nodal Disease after Chemoradiation for Advanced Head and Neck Cancer

• Published in: The Laryngoscope Vol. 116; no. 5; pp. 705 - 710
• Main Authors: Gourin, Christine G., Williams, Haydn T., Seabolt, Wesley N., Herdman, Anne V., Howington, Jed W., Terris, David J.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Hoboken, NJ John Wiley & Sons, Inc 01-05-2006; Wiley-Blackwell
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy, Needle; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemotherapy, Adjuvant; Cohort Studies; Female; Follow-Up Studies; head and neck neoplasms; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Immunohistochemistry; Male; Medical sciences; Middle Aged; neck dissection; Neoplasm Invasiveness - pathology; Neoplasm Staging; Neoplasm, Residual - diagnostic imaging; Neoplasm, Residual - pathology; nodal metastases; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; PET-CT; Positron-Emission Tomography; Probability; Radiotherapy, Adjuvant; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; squamous cell cancer; Survival Analysis; Tomography, X-Ray Computed; treatment; Treatment Outcome; Tumors; Radionuclide study; head and neck neoplasms; nodal metastases; squamous cell cancer; Radiodiagnosis; PET-CT; Identification; Malignant tumor; Metastasis; Chemoradiotherapy; Treatment; Surgery; Adenopathy; Head and neck; Medical imagery; ENT disease; Advanced stage; Head and neck cancer; Computerized axial tomography; neck dissection; Neck; Dissection; Positron emission tomography; Emission tomography
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/01.MLG.0000215176.98582.A9

Objectives: Planned neck dissection after chemoradiation (CR) is often advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease who demonstrate a clinical complete response to CR because identification of residual occult nodal disease is difficult. We sought to investigate the utility of positron emission tomography‐computed tomography (PET‐CT) in identifying patients with occult nodal disease after CR.
Study Design: Nonrandomized retrospective cohort analysis.
Materials and Methods: The medical records of all patients treated with primary CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2005 were reviewed. Patients with a clinical complete response were eligible for inclusion if PET‐CT performed at 8 to 10 weeks after CR showed no evidence of distant disease and they were treated with a planned neck dissection.
Results: Seventeen patients met study criteria. PET‐CT was positive for residual nodal disease in 11 (64.7%) patients, with a standardized uptake value (SUV) range of 1.7 to 3.8. Pathologic examination revealed residual viable carcinoma in five (29.4%) patients, with tumor size ranging from 2.0 to 9.5 mm. Carcinoma was present in 2 of 11 (18.2%) patients with positive PET‐CT scans and 3 of 6 (50%) patients with negative PET‐CT scans. The sensitivity and specificity of PET‐CT in predicting occult nodal disease was 40% and 25%, respectively. There was no correlation between PET‐CT findings and histologic findings (P = .26) or between SUV and size of viable tumor (P = .67).
Conclusions: A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET‐CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.