Does ¹⁸F-FDG PET/CT Improve the Detection of Posttreatment Recurrence of Head and Neck Squamous Cell Carcinoma in Patients Negative for Disease on Clinical Follow-up?

Abstract

Posttreatment surveillance for the recurrence of head and neck squamous cell carcinoma (HNSCC) is a diagnostic challenge. Tissue distortion from radiation and surgery can obscure early detection of recurrence by conventional follow-up approaches such as physical examination, CT, and MRI. Several studies have shown that 18 F-FDG PET may be an effective technique for the detection of persistent, recurrent, and distant metastatic HNSCC after treatment. The aim of this prospective study was to determine the benefits of hybrid 18 F-FDG PET/CT in detecting a subclinical locoregional recurrence of HNSCC and distant metastases. The study patients were considered cured of HNSCC on the basis of 12 mo of negative findings on conventional follow-up. We also assessed the diagnostic accuracy of 18 F-FDG PET/CT in these patients. Methods: Ninety-one patients cured of HNSCC without any clinical evidence of recurrence were included. Whole-body 18 F-FDG PET/CT examination was performed 11.6 6 4.4 mo after the end of the treatment. The gold standard was histopathology or 6 mo of imaging follow-up. Results: The whole-body 18 F-FDG PET/CT examinations had negative results in 52 patients and positive results in 39. Nine of these patients who exhibited abnormal 18 F-FDG uptake in the head and neck area did not have recurrent HNSCC (false-positive). Thirty had proven recurrence. The sensitivity and specificity of 18 F-FDG PET/CT in this study for the diagnosis of HNSCC recurrence were 100% (30/30) and 85% (52/61), respectively. The positive predictive value was 77% (30/39). The negative predictive value was 100% (52/52). The overall accuracy was 90% (82/91). Conclusion: The results of our study confirm the high effectiveness of 18 F-FDG PET/CT in the assessment of HNSCC recurrence and suggest that 18 F-FDG PET/CT is more accurate than conventional follow-up physical examination alone in the assessment of recurrence after previous curative treatment for HNSCC and could be proposed systematically at 12 mo of the usual follow-up.

18F-FDG PET as a Routine Posttreatment Surveillance Tool in Oral and Oropharyngeal Squamous Cell Carcinoma: A ProspectiveStudy

“…PET 1 and 2 detected malignancy in 16 of the 18 patients and thus, 18 F-FDG PET performed at 3-6 mo after therapy, in accordance with the findings of a retrospective study by Lee et al (26), was the best timing for imaging after treatment. In 2 studies, systematic 18 F-FDG PET/CT showed a high accuracy at 12 mo after treatment (27,28). However, the authors suggested a higher impact of 18 F-FDG PET at 6 mo after treatment, because the 18 F-FDG PET at 12 mo after treatment had significantly less impact than did earlier performed 18 F-FDG PET motivated by clinical suspicion (27).…”

Addition of 18F-FDG PET/CT to Clinical Assessment Predicts Overall Survival in HNSCC: A Retrospective Analysis with Follow-up for 12 Years

“…Treatment with radiotherapy and surgery causes inflammation, scarring, and tissue distortion, which can limit the interpretation of anatomic imaging techniques such as CT and MR imaging (9,10). In contrast, the metabolic information provided by 18 F-FDG PET/CT allows it to serve as an effective tool for detecting recurrence, regional lymphatic spread, and distant metastases (11).…”

“…The value of follow-up PET/CT for patient outcome, and the added value to the clinical assessment, are not fully established. Previous studies (11,(19)(20)(21) have shown the prognostic significance of follow-up PET or PET/CT performed within 1 y after the completion of therapy. A recent study demonstrated the temporal patterns of HNSCC recurrence with 18 F-FDG PET/CT and concluded that PET/CT detected 73 asymptomatic recurrences in 110 patients with recurrence, with 95% of the observed recurrences being detected within 24 mo (22).…”

Innovations in Radiotherapy Planning of Head and Neck Cancers: Role of PET

“…The role of 18 F-FDG PET or 18 F-FDG PET/CT for the early detection of recurrent disease is addressed elsewhere (3,5,6).…”