PET and PET/CT of the Neck Lymph Nodes Improves Risk Prediction in Patients with Squamous Cell Carcinoma of the Oral Cavity

Abstract

We prospectively evaluated the sensitivity and specificity of 18 F-FDG PET in the detection of neck lymph node metastases in patients with oral cavity squamous cell carcinoma (OSCC). We also sought to evaluate whether pretreatment PET visual scores in the neck lymph nodes may improve risk stratification. Methods: We enrolled 473 OSCC patients (445 men and 28 women; mean age 6 SD, 50.9 6 11.7 y) without distant metastases. All participants underwent 18 F-FDG PET within 2 wk before surgery and neck dissection. Histopathology was taken as the reference standard for neck lymph node status. The duration of follow-up was at least 24 mo in all surviving patients. Results: 18 F-FDG PET correctly diagnosed 164 of 211 patients with neck metastases and 152 of 262 subjects without pathologic neck metastases, resulting in a patient-based sensitivity and specificity of 77.7% and 58.0%, respectively. In Cox models adjusting for age, sex, traditional risk factors, and treatment modality, PET results at the neck lymph nodes were significantly and independently associated with rates of neck control, distant metastasis, disease-free survival, disease-specific survival, and overall survival. Notably, the results of the c-statistics demonstrated that PET score improved the accuracy of risk prediction in terms of overall and disease-free survival rates. Conclusion: PET findings at the neck lymph nodes have limited sensitivity and specificity for primary staging of OSCC but improve risk stratification beyond that of traditional risk factors.

Bringing Physiology into PET of the Liver

“…Accordingly, several attempts have been made to estimate the dual-input time–activity curve from dynamic PET data without the need for invasive blood flow or concentration measurements (11,12). However, as yet, no method has successfully solved the problems of partial-volume effects of the PV, which unavoidably affect the time–activity curve because of the size of the vessel and respiratory movements.…”

Prognostic significance of standardized uptake value and metabolic tumour volume on 18F-FDG PET/CT in oropharyngeal squamous cell carcinoma

“…18 F-FDG PET/ CT can improve risk prediction and shows prognostic value as a biomarker of HNSCC [14,15]. The maximum standardized uptake value (SUV max ), which is currently the most commonly used parameter in 18 F-FDG PET/CT [12,13,16], is an easily readable value that can be determined by estimating the highest intensity of 18 F-FDG uptake.…”

18F-FDG Metabolic Tumor Volume and Total Glycolytic Activity of Oral Cavity and Oropharyngeal Squamous Cell Cancer: Adding Value to Clinical Staging

“…Identification of novel pretreatment imaging biomarkers that potentially predict long-term outcome is of great interest. PET/CT standardized uptake value (SUV) measurements are reproducible imaging biomarkers that have diagnostic and prognostic value in HNSCC in general (5,6) and in oral and oropharyngeal SCC specifically (7). Recently, 18 F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been reported as additional diagnostic and prognostic imaging biomarkers in various human solid tumors (8)(9)(10)(11).…”