The value of whole-body contrast-enhanced 18F-FDG PET/CT imaging in the diagnosis and staging of patients with laryngeal carcinoma

Tatar, Gamze; Çermik, Tevfik Fikret; Karagöz, Yeşim; Gündoğan, Cihan; Karaçetin, Didem; Yildiz, Elif; Yiğit, Özgür

doi:10.1097/mnm.0000000000000809

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…Preoperative use of the PET scan was not associated with a lower frequency of stage change. In a sample of 45 laryngeal cancer patients randomized to PET/CT versus MRI/CT, Tatar et al demonstrated diagnostic accuracy of 86.6% with PET/CT compared with 44.4% for MRI/CT 22 . Other studies similarly found improved accuracy with PET scan, but a false‐positive rate of 27% in cervical nodes is also reported 23,24 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

et al. 2020

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Objectives/Hypothesis Evaluate the impact and accuracy of clinical laryngeal cancer staging. Study Design Retrospective cohort study. Methods Two hundred sixty‐five consecutive patients with laryngeal squamous cell carcinoma who underwent total laryngectomy from 2001 to 2017 were studied. Clinical versus pathologic tumor (T) and nodal (N) categories were compared. Logistic regression and Cox proportional hazards analyzed the association of stage change with perioperative factors and outcomes. Results Forty‐seven patients (17.7%, accuracy = 0.969 ± 0.010 [standard error]) changed between T1‐2 and T3‐4. Sixty‐four patients (24.1%, accuracy = 0.866 ± 0.020) had inaccurate N category. Salvage patients were less likely to have stage change (downstage: odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.08‐0.50, P < .001; upstage: OR = 0.41, 95% CI: 0.23‐0.74, P = .003), but more likely to have inaccurate nodal category (39.8% vs. 11.7%, P < .001). Patients with stage change tended to have greater odds of positive/close margins (upstage: OR = 1.78, 95% CI: 0.91‐3.5, P = .092) and chemotherapy (downstage: OR = 2.21, 95% CI: 0.80‐6.14, P = .128; upstage: OR = 1.87, 95% CI: 0.85‐4.11, P = .119). Stage change was associated with recurrence (P = .047) with downstaged patients less likely to recur (hazard ratio = 0.26, 95% CI: 0.08‐0.82, P = .021). Stage change was not associated with positron emission tomography scan, subsite, time to surgery, or mortality. Conclusions A third of laryngeal cancer patients were downstaged or upstaged after laryngectomy with 18% and 24% of clinical T and N categories inaccurate, respectively. Stage change was less common for salvage patients and associated with risk of recurrence. Level of Evidence 3 Laryngoscope, 131:559–565, 2021

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Section: Discussionmentioning

confidence: 99%

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

et al. 2020

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“…Literature on the value of FDG PET/CT imaging in the diagnosis and staging of patients with laryngeal carcinoma shows a higher sensitivity (100%) than MRI/CT (93.3%); additionally, FDG PET/CT is able to detect regional nodal and distant metastasis, as well as synchronous tumors [34]. Reasons for the lower accuracy of FDG PET/CT in restaging of laryngeal carcinoma after organ-preserving non-surgical treatment may be false-positive results due to inflammation, edema, or protracted mucositis/laryngitis, which increase the necessity of laryngoscopies with biopsies under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Routine restaging after primary non-surgical treatment of laryngeal squamous cell carcinoma—a review

et al. 2020

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Purpose Treatment of patients with laryngeal squamous cell carcinoma with radiotherapy or chemoradiation is an established alternative to laryngeal surgery in many cases, but particularly for advanced tumors without cartilage invasion. Imaging modalities face the challenge of distinguishing between posttherapeutic changes and residual disease in the complex anatomic subsite of the larynx. Guidelines concerning restaging of head and neck squamous cell carcinomas (HNSCC) are presented by the National Comprehensive Cancer Network (NCCN) and other national guidelines, but clearly defined recommendations for routine restaging particularly for laryngeal cancer are lacking. Methods A systematic search was carried out in PubMed to identify studies evaluating routine restaging methods after primary non-surgical treatment of laryngeal squamous cell carcinoma from 2009 to 2020. Results Only three studies were deemed eligible, as they included at least ≥50% patients with laryngeal squamous cell carcinoma and evaluated imaging modalities to detect residual cancer. The small number of studies in our review suggest restaging with fluoro-deoxy-glucose positron-emission tomography/computed tomography (FDG PET/CT) 3 months after initial treatment, followed by direct laryngoscopy with biopsy of the lesions identified by FDG PET/CT. Conclusion Studies evaluating restaging methods after organ-preserving non-surgical treatment of laryngeal carcinoma are limited. As radiotherapy (RT), chemoradiotherapy (CRT), systemic therapy followed by RT and radioimmunotherapy are established alternatives to surgical treatment, particularly in advanced laryngeal cancers, further studies are needed to assess and compare different imaging modalities (e.g. PET/CT, MRI, CT, ultrasound) and clinical diagnostic tools (e.g., video laryngoscopy, direct laryngoscopy) to offer patients safe and efficient restaging strategies. PET or PET/CT 3 months after initial treatment followed by direct laryngoscopy with biopsy of the identified lesions has the potential to reduce the number of unnecessary laryngoscopies.

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“…Finally, in the setting of persistent or recurrent LSCC after (C)RT, systemic imaging should be employed to rule out distant metastasis. PET/CT scan, carried out at least 12 weeks after treatment, demonstrated an adequate diagnostic potential in LSCC and head and neck cancer in general [41][42][43]. However, its effectiveness in detecting occult nodal metastases in recurrent LSCC remains debated [44].…”

Section: Radiologic Evaluationmentioning

confidence: 99%

Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement

Piazza

Paderno

Sjögren

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. Methods Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. Results The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. Conclusion Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.

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The value of whole-body contrast-enhanced 18F-FDG PET/CT imaging in the diagnosis and staging of patients with laryngeal carcinoma

Cited by 11 publications

References 30 publications

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

Routine restaging after primary non-surgical treatment of laryngeal squamous cell carcinoma—a review

Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement

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