Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck

• Published in: Journal of Nuclear Medicine Vol. 50; no. 8; pp. 1205 - 1213
• Main Authors: Rodrigues, Rosana S, Bozza, Fernando A, Christian, Paul E, Hoffman, John M, Butterfield, Regan I, Christensen, Carl R, Heilbrun, Marta, Wiggins, Richard H., III, Hunt, Jason P, Bentz, Brandon G, Hitchcock, Ying J, Morton, Kathryn A
• Format: Journal Article
• Language: English
• Published: United States Soc Nuclear Med 01.08.2009; Society of Nuclear Medicine
• Subjects: Adult; Aged; Aged, 80 and over; Breast cancer; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Contrast Media; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - surgery; Humans; Image Enhancement - methods; Lymphatic Metastasis; Metastasis; Middle Aged; Neoplasm Staging; Patients; Positron-Emission Tomography - methods; Preoperative Care; Protocol; Radiation therapy; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique; Surgery; Tomography; Tomography, X-Ray Computed - methods; Whole Body Imaging - methods
• ISSN: 0161-5505; 1535-5667; 2159-662X
• DOI: 10.2967/jnumed.109.062075

The purpose of this study was to compare optimized whole-body (WB) and dedicated high-resolution contrast-enhanced PET/CT protocols and contrast enhanced CT in the preoperative staging of primary squamous cell carcinoma of the head and neck. A total of 44 patients with clinically M0 squamous cell carcinoma of the head and neck underwent primary tumor resection and neck dissection within 6 wk of diagnostic imaging. Imaging consisted of a standard WB PET/CT protocol without intravenous contrast enhancement, followed by a high-resolution dedicated head and neck (HN) PET/CT protocol, which included diagnostic-quality contrast-enhanced CT (CECT). Imaging results were compared with histopathology. A 5-point scale was used to designate primary tumor localization and the presence of lymph node metastasis on a per-patient and per-level basis. For cervical nodes, receiver-operating-characteristic curves were generated to determine the differences in performance between the WB and HN PET/CT protocols and CECT. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for primary tumor and cervical nodes. No statistical difference was observed between WB and HN PET/CT protocols, both of which significantly outperformed CECT, in the evaluation of the primary tumor. The performance of the HN PET/CT protocol was superior to that of the WB PET/CT in the detection of cervical node metastases, achieving statistical significance on a per-level basis and approaching significance on a per-patient basis, with the greatest advantage in the detection of small positive lymph nodes (<15 mm). No significant difference was observed between the WB PET/CT protocol and CECT in nodal staging, either on a per-patient or on a per-level basis. The primary advantage of the dedicated HN PET/CT protocol over the WB protocol or CECT in the staging of head and neck cancer is in the detection of small lymph node metastases.