Head-to-Head Comparison of Chest X-Ray/Head and Neck MRI, Chest CT/Head and Neck MRI, and ¹⁸F-FDG PET/CT for Detection of Distant Metastases and Synchronous Cancer in Oral, Pharyngeal, and Laryngeal Cancer

Abstract

The purpose of this study was to determine the detection rate of distant metastasis and synchronous cancer, comparing clinically used imaging strategies based on chest x-ray + head and neck MRI (CXR/MRI) and chest CT + head and neck MRI (CHCT/MRI) with F-FDG PET/CT upfront in the diagnostic workup of patients with oral, pharyngeal, or laryngeal cancer. This was a prospective cohort study based on paired data. Consecutive patients with histologically verified primary head and squamous cell carcinoma at Odense University Hospital from September 2013 to March 2016 were considered for the study. Included patients underwent CXR/MRI and CHCT/MRI as well as PET/CT on the same day and before biopsy. Scans were read masked by separate teams of experienced nuclear physicians or radiologists. The true detection rate of distant metastasis and synchronous cancer was assessed for CXR/MRI, CHCT/MRI, and PET/CT. A total of 307 patients were included. CXR/MRI correctly detected 3 (1%) patients with distant metastasis, CHCT/MRI detected 11 (4%) patients, and PET/CT detected 18 (6%) patients. The absolute differences of 5% and 2%, respectively, were statistically significant in favor of PET/CT. Also, PET/CT correctly detected 25 (8%) synchronous cancers, which was significantly more than CXR/MRI (3 patients, 1%) and CHCT/MRI (6 patients, 2%). The true detection rate of distant metastasis or synchronous cancer with PET/CT was 13% (40 patients), which was significantly higher than 2% (6 patients) for CXR/MRI and 6% (17 patients) for CHCT/MRI. A clinical imaging strategy based on PET/CT demonstrated a significantly higher detection rate of distant metastasis or synchronous cancer than strategies in current clinical imaging guidelines, of which European ones primarily recommend CXR/MRI, whereas U.S. guidelines preferably point to CHCT/MRI in patients with head and neck squamous cell carcinoma.

Distant metastases and synchronous malignancies on FDG-PET/CT in patients with head and neck cancer: a retrospective study

“…The majority of the distant metastases, 14 of 21 findings, were located in the thoracic region, which is slightly lower than reported in a recently published Danish study on oropharyngeal and laryngeal cancer, in which all patients with distant metastases (18/307) had thoracic involvement (7). In this study, all nine distant metastases from a head and neck SCC were situated above the diaphragm; all but one could be identified by CT of the thorax alone.…”

PET/CT versus PET/MRT bei Kopf-Hals-Tumoren

“…Eine aktuelle Metaanalyse von Xu zeigte, dass die 18 F-FDG-PET/CT eine Sensitivität von 92 % und eine Spezifität von 95 % für die Detektion von Fernmetastasen aufweist [30]. Im Jahre 2017 konnten zudem Rohde et al in einer prospektiven Studie erstmals zeigen, dass die 18 F-FDG-PET/CT signifikant mehr Metastasen und synchrone Zweittumore detektieren konnte als das Thorax-Röntgen oder das Thorax-CT [31].…”

PET/CT Versus Standard Imaging for Prediction of Survival in Patients with Recurrent Head and Neck Squamous Cell Carcinoma

“…We conducted a masked prospective cohort study based on paired data. The overall cohort has previously been used for publications concerning patients with primary HNSCC (22)(23)(24). This study examined recurrent HNSCC, which constituted a different subgroup of patients from our overall cohort.…”

“…Muscle metastases were suspected in patients with randomly distributed focal areas of increased 18 F-FDG uptake in the muscles if there were corresponding morphologic changes on CXR or CCT. Finally, longitudinal muscular 18 F-FDG uptake was considered to be physiologic (22).…”