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1- Apport du TEP scanner au [18F]-FDG dans les adénopathies cervicales
primitives Original Research Article
Annales d'Otolaryngologie et de Chirurgie Cervico-Faciale, Volume 123, Issue 1, January
2006, Pages 17-25
N. Fakhry, T. Jacob, J. Paris, M. Barberet, O. Mundler, A. Giovanni, M. Zanaret
Objectives
To evaluate the usefulness of fusioning positron emission tomography withcomputed tomography
(PET/CT) for the detection of head and neck carcinomas of unknown primary.
Methods
This prospective study included 20 patients with cervical lymph node of squamous.cell carcinoma of
unknown primary after standard initial workup (nasofibroscopy and CT scan of the chest and head and
neck). Patients underwent PET/CT and panendoscopy ofthe upper airways and upper digestive tract
with PET/CT directed biopsies. The follow-up was 6 months minimum in all patients.
Results
A potential primary tumor was found in 10 of the 20 cases and confirmed by histology.in 7 cases (3
bases of tongue, 1 tonsillar pillar, 1 vallecula, 1 tonsillar fossa, 1 piriformsinus). Four of these seven
patients presented a normal endoscopy (diagnosis was made with submucosal PET/CT directed
biopsies). PET/CT was normal in 10 of 20 cases with 3 false negatives. The sensitivity of PET/CT was
70%, the specificity was 70% and the accuracy was 70%.
Conclusion
PET/CT seems to be of interest in the detection of head and neck carcinoma of unknown primary.
PET/CT detected 15% of unknown primary tumors with treatmentrelated implications.
Objectifs
Évaluer l’intérêt de la fusion de la tomographie par émission de positons au 18F-fluoro-2-deoxy-Dglucose (FDG) avec la tomodensitométrie (TEP/TDM) dans le dépistage
2- J Nucl Med. 2007 May;48(5):726-35.
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18F-FLT PET does not discriminate between reactive and metastatic lymph nodes in
primary head and neck cancer patients.
Troost EG, Vogel WV, Merkx MA, Slootweg PJ, Marres HA, Peeters WJ, Bussink J, van der Kogel
AJ, Oyen WJ, Kaanders JH.
Source
Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen,
The Netherlands. [email protected]
Abstract
Repopulation of clonogenic tumor cells is inversely correlated with radiation treatment outcome in
head and neck squamous cell carcinomas. A functional imaging tool to assess the proliferative
activity of tumors could improve patient selection for treatment modifications and could be used
for evaluation of early treatment response. The PET tracer 3'-deoxy-3'-(18)F-fluorothymidine
((18)F-FLT) can image tumor cell proliferation before and during radiotherapy, and it may provide
biologic tumor information useful in radiotherapy planning. In the present study, the value of
(18)F-FLT PET in determining the lymph node status in squamous cell carcinoma of the head and
neck was assessed, with pathology as the gold standard.
METHODS:
Ten patients with newly diagnosed stage II-IV squamous cell carcinoma of the head and neck
underwent (18)F-FLT PET before surgical tumor resection with lymph node dissection. Emission
(18)F-FLT PET and CT images of the head and neck were recorded and fused, and standardized
uptake values (SUVs) were calculated. From all 18 (18)F-FLT PET-positive lymph node levels
and from 8 (18)F-FLT PET-negative controls, paraffin-embedded lymph node sections were
stained and analyzed for the endogenous proliferation marker Ki-67 and for the preoperatively
administered proliferation marker iododeoxyuridine. The sensitivity, specificity, positive
predictive value, and negative predictive value were calculated for (18)F-FLT PET.
RESULTS:
Primary tumor sites were oral cavity (n=7), larynx (n=2), and maxillary sinus (n=1). Nine of the 10
patients examined had (18)F-FLT PET-positive lymph nodes (SUV(mean): median, 1.2; range,
0.8-2.9), but only 3 of these patients had histologically proven metastases. All metastatic lymph
nodes showed Ki-67 and iododeoxyuridine staining in tumor cells. In the remaining 7 patients,
there was abundant Ki-67 and iododeoxyuridine staining of B-lymphocytes in germinal centers in
PET-positive lymph nodes, explaining the high rate of false-positive findings. The sensitivity,
specificity, positive predictive value, and negative predictive value of (18)F-FLT PET were 100%,
16.7%, 37.5%, and 100%, respectively.
CONCLUSION:
In head and neck cancer patients, (18)F-FLT PET showed uptake in metastatic as well as in
nonmetastatic reactive lymph nodes, the latter due to reactive B-lymphocyte proliferation. Because
of the low specificity, (18)F-FLT PET is not suitable for assessment of pretreatment lymph node
status. This observation may also negatively influence the utility of (18)F-FLT PET for early
treatment response evaluation of small metastatic nodes.
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3- Database of Abstracts of Reviews of Effects (DARE)
18F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in
patients with head and neck squamous cell carcinoma: a meta-analysis
Kyzas PA, Evangelou E, Denaxa-Kyza D, Ioannidis JP
CRD summary
Authors'
objectives
Searching
Study selection
This review assessed the accuracy of 18F-fluorodeoxyglucose positron emission
tomography (FDG-PET) in detecting lymph node metastases in head and neck
squamous cell carcinoma and compared it with conventional tests (computed
tomography, magnetic resonance imaging and ultrasound with fine-needle
aspiration). The authors' conclusion that all of these tests have similarly poor
performance is likely to be reliable.
To assess the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission
tomography (FDG-PET) in detecting lymph node metastases in patients with head
and neck squamous cell carcinoma (HNSCC) and to compare its performance with
other tests: computed tomography (CT); magnetic resonance imaging (MRI); and
ultrasound with fine-needle aspiration (USFNA).
MEDLINE was searched to July 2007. Search terms, based on the index test and
the target condition, were reported. The bibliographies of retrieved articles were
screened for additional studies. No language restrictions were applied.
Studies that evaluated FDG-PET for detecting lymph node metastases at initial
staging before surgery in patients with HNSCC were eligible for inclusion. Studies
had to include at least five patients with HNSCC and patients with and without
lymph node metastases as determined by histopathologic examination (reference
standard). Studies with verification bias (those in which the reference standard of
histopathologic examination was performed only in FDG-PET-positive patients)
were excluded. Studies that used FDG-PET to assess post-treatment recurrence and
studies in which patients received chemotherapy or radiotherapy before neck
dissection were excluded. FDG-PET positivity was defined as qualitative for most
included studies. All but two of the included studies assessed at least one
comparator test in addition to FDG-PET. Where reported, the proportion of cN0
(clinically negative cervical lymph nodes) patients ranged from 0 to 100%.
The authors stated neither how studies were selected for the review nor how many
reviewers performed the selection.
Validity
assessment
The authors did not state that they assessed study validity, but studies with
verification bias were excluded and study design (prospective or retrospective) and
blinding were recorded.
The absolute numbers of true positive, false negative, false positive and true
negative results were extracted for each test (FDG-PET, CT, MRI and USFNA).
Investigators were contacted where data were missing. Data were also extracted on
the clinical node staging of study populations: patients with clinically positive
Data extraction cervical lymph nodes (cN1, cN2 and cN3), patients with clinically negative cervical
lymph nodes (cN0) and mixed populations.
Two reviewers independently extracted data. Differences were resolved by
discussion or consultation with a third reviewer.
Methods of
Diagnostic performance data were combined using a hierarchical regression model
to generate summary receiver operating characteristic (SROC) curves and summary
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synthesis
estimates of per patient sensitivity and specificity, with 95% confidence intervals
(CIs), for FDG-PET. The summary estimates of sensitivity and specificity derived
from meta-analyses were used to calculate positive and negative likelihood ratios
(LRs) and negative predictive values (NPVs) for a range of population prevalences
of node metastases. The hierarchical regression model was used to compare the
diagnostic performance of FDG-PET with that of conventional tests (CT, MRI,
CT/MRI and USFNA) individually or as a group; for group data a positive result
was defined as a positive result from at least one conventional test.
Subgroup analyses were performed for clinical N stage (cN positive, cN0 and
mixed), definition of FDG-PET positive (quantitative, qualitative and unclear),
study design (prospective or retrospective) and blinding (yes, no and not reported).
Thirty five studies were included in the review; 32 studies with a total of 1,236
participants were included in the meta-analyses. Sixteen studies were prospective,
10 retrospective and nine unclear. Six of the included studies were blinded, five
were unblinded and the blinding status of 16 was unclear. Nineteen studies assessed
the positivity of FDG-PET qualitatively and eight used quantitative definitions.
Results of the
review
The overall sensitivity and specificity estimates for FDG-PET (32 studies) were
79% (95% CI 72 to 85) for sensitivity and 86% (95% CI 83 to 89) for specificity.
Sensitivity was reduced for studies of cN0 patients only, 50% (95% CI 37 to 63;
10 studies, 311 participants) and for studies that reported blinded interpretation of
FDG-PET, 72% (95% CI 51 to 87; five studies, 278 participants); specificity
estimates were similar to that for the overall population in both cases. Study design
and type of assessment of FDG-PET positivity did not significantly effect
diagnostic accuracy.
When FDG-PET was compared with conventional diagnostic tests as a group (24
studies) and individually (16 studies for CT, nine studies for MRI, four studies for
CT/MRI and four studies for USFNA), no significant differences were found. A
comparison of FDG-PET with conventional diagnostic tests as a group in cN0
patients (five studies) found no significant differences.
Likelihood ratios for FDG-PET and conventional tests and NPVs for FDG-PET
were also reported.
Authors'
conclusions
CRD
commentary
18
F-FDG-PET had good diagnostic performance in the overall evaluation of patients
with head and neck squamous cell carcinoma prior to surgical treatment. However,
it failed to detect disease in half of patients with metastases and clinically negative
cervical lymph nodes.
The review addressed a clearly stated research question defined by appropriate
inclusion criteria. The search strategy was limited to MEDLINE and reference
screening, so some relevant studies may have been missed. No language restrictions
were applied and a search strategy aimed at maximising sensitivity (based on index
test and target condition only) was used. Measures to minimise error and bias were
applied to the data extraction process, but it was unclear whether similar methods
were used in the selection of studies for the review. The authors did not explicitly
state that they assessed the methodological quality of included studies, but the
presence of verification bias was used as an exclusion criterion and other aspects of
study quality were extracted and their impact on test performance considered using
subgroup analyses. Robust meta-analytic methods were used to synthesise data and
despite some limitations in the review process the authors' conclusions are likely to
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be reliable.
Implications of
the review for
practice and
research
Practice: The authors stated that there was no solid evidence to support the routine
clinical application of 18F-FDG-PET in the pretreatment evaluation of lymph node
status in patients with HNSCC, including patients with clinically negative neck.
They further stated that other imaging methods appeared to have similarly limited
or worse diagnostic performance in these patients. Consideration of cost and
potential complications versus potential information yield can be considered on a
case-by-case basis.
Research: The authors stated that larger studies may clarify whether the use of 18FFDG-PET offered an incremental improvement over conventional imaging
methods.
Funding
Bibliographic
detail
Not reported.
Kyzas PA, Evangelou E, Denaxa-Kyza D, Ioannidis JP. 18F-fluorodeoxyglucose
positron emission tomography to evaluate cervical node metastases in patients
with head and neck squamous cell carcinoma: a meta-analysis. Journal of the
National Cancer Institute 2008; 100(10): 712-720
Link to Pubmed
18477804
record
URL for original
http://jnci.oxfordjournals.org/cgi/content/full/100/10/712
research
Subject index
terms status
Subject indexing assigned by NLM
Subject index
terms
Confidence Intervals; Fluorodeoxyglucose F18 /diagnostic use; Head and Neck
Neoplasms /pathology /radionuclide imaging; Humans; Lymph Nodes /pathology
/radionuclide imaging; Lymphatic Metastasis; Neck; Neoplasm Staging; PositronEmission Tomography /methods; Predictive Value of Tests; Radiopharmaceuticals
/diagnostic use; ROC Curve; Sensitivity and Specificity
Accession
number
Database entry
date
12008103934
16 ecember 2009
4- Acta Med Okayama. 2008 Jun;62(3):205-8.
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Can narrow-band imaging be used to determine the surgical margin of superficial
hypopharyngeal cancer?
Orita Y, Kawabata K, Mitani H, Fukushima H, Tanaka S, Yoshimoto S, Yamamoto N.
Source
Department of Otolaryngology-Head and Neck Surgery, Okayama Saiseikai General Hospital,
Okayama 700-8511, Japan. [email protected]
Abstract
Narrow-band imaging (NBI) is a novel optical technique that uses narrow bandwidth filters in a video
endoscope system to improve the diagnostic capability of endoscopes in characterizing tissues. It is
well known that early identification of neoplasia in the gastrointestinal tract using this technique might
make it possible to reduce the suffering of patients caused by loss of function or severe complications
after radical surgery. Several reports have introduced this system as a preoperative examination to
evaluate the lateral spread of the neoplastic lesions in the oropharynx or hypopharynx. We experienced
a case with hypopharyngeal cancer in which we were able to avoid underestimating cancer lesions
following insufficient resection using the NBI system. A 62-year-old female underwent partial
hypopharyngectomy with the margin estimated by an NBI view coupled with reconstruction of the
hypopharynx while preserving the larynx. The resected specimen was cut into serial sections for a
detailed pathology examination. The surgical margin seemed to be wide enough and it could be
assumed that if possible we should observe these cancers with conventional electroendoscopy and NBI
before treatment.
5- Head Neck. 2010 Mar;32(3):368-74.
Detection of cervical metastases with (11)C-tyrosine PET in patients with squamous cell
carcinoma of the oral cavity or oropharynx: A comparison with (18)F-FDG PET.
Krabbe CA, van der Werff-Regelink G, Pruim J, van der Wal JE, Roodenburg JL.
Source
Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The
Netherlands. [email protected]
Abstract
BACKGROUND:
A disadvantage of 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography
(PET) in head and neck cancer is that (18)F-FDG uptake is not specific to malignant tissue. To provide
an alternative, radiolabeled amino acids such as L-1-[(11)C]-tyrosine ((11)C-TYR), were introduced
because these are less avidly metabolized by inflammatory cells.
METHODS:
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In this prospective study, we compared both (11)C-TYR PET and (18)F-FDG PET performance in
detecting cervical metastases in 27 patients with a squamous cell carcinoma (SCC) of oral cavity or
oropharynx.
RESULTS:
(11)C-TYR PET sensitivity, specificity, and accuracy for detecting nodal metastases were 33%, 100%,
and 81%, respectively. With respect to (18)F-FDG PET, these figures were 67%, 97%, and 89%,
respectively. Neck metastases not detected by (11)C-TYR PET were camouflaged by high tracer
uptake by salivary glands.
CONCLUSIONS:
Because of bilateral accumulation of (11)C-TYR in salivary glands, (11)C-TYR PET is not suitable to
replace (18)F-FDG PET in staging SCC of oral cavity and oropharynx.
6- eans of biopsy, cliNeuroradiology. 2008 Nov;50(11):969-79. Epub 2008 Jul 4.
Distant metastases and synchronous second primary tumors in patients with newly
diagnosed oropharyngeal and hypopharyngeal carcinomas: evaluation of (18)F-FDG PET
and extended-field multi-detector row CT.
Ng SH, Chan SC, Liao CT, Chang JT, Ko SF, Wang HM, Chin SC, Lin CY, Huang SF, Yen TC.
Source
Department of Molecular Imaging Center and Diagnostic Radiology, Chang Gung Memorial Hospital,
Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan.
Abstract
INTRODUCTION:
Patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (SCC) have a high risk of
having distant metastases or second primary tumors. We prospectively evaluate the clinical usefulness
of (18)F-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG PET), extended-field
multi-detector computed tomography (MDCT), and their side-by-side visual correlation for the
detection of distant malignancies in these two tumors at presentation.
MATERIALS AND METHODS:
A total of 160 patients with SCC of the oropharynx (n = 74) or hypopharynx (n = 86) underwent
(18)F-FDG PET and extended-field MDCT to detect distant metastases or second primary tumors.
Suspected lesions were investigated by m nical, or imaging follow-up.
RESULTS:
Twenty-six (16.3%) of our 160 patients were found to have distant malignancy. Diagnostic yields of
(18)F-FDG PET and MDCT were 12.5% and 8.1%, respectively. The sensitivity of (18)F-FDG PET
for detection of distant malignancies was 1.5-fold higher than that of MDCT (76.9% vs. 50.0%, P =
0.039), while its specificity was slightly lower (94.0% vs. 97.8%, P = 0.125). Side-by-side visual
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correlation of MDCT and (18)F-FDG PET improved the sensitivity and specificity up to 80.8% and
98.5%, respectively, leading to alteration of treatment in 13.1% of patients. A significant difference in
survival rates between its positive and negative results was observed.
CONCLUSION:
(18)F-FDG PET and extended-field MDCT had acceptable diagnostic yields for detection of distant
malignancies in untreated oropharyngeal and hypopharyngeal SCC. (18)F-FDG PET was 1.5-fold
more sensitive than MDCT, but had more false-positive findings. Their visual correlation improved
the diagnostic accuracy, treatment planning, and prognosis prediction.
7- J Clin Oncol. 2010 Mar 20;28(9):1566-72. Epub 2010 Feb 22.
Early detection of superficial squamous cell carcinoma in the head and neck region and
esophagus by narrow band imaging: a multicenter randomized controlled trial.
Muto M, Minashi K, Yano T, Saito Y, Oda I, Nonaka S, Omori T, Sugiura H, Goda K, Kaise M, Inoue H,
Ishikawa H, Ochiai A, Shimoda T, Watanabe H, Tajiri H, Saito D.
Source
Department of Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan.
[email protected]
Abstract
PURPOSE:
Most of the esophageal squamous cell carcinomas (ESCCs) and cancers of the head and neck (H&N)
region are diagnosed at later stages. To achieve better survival, early detection is necessary. We
compared the real-time diagnostic yield of superficial cancer in these regions between conventional
white light imaging (WLI) and narrow band imaging (NBI) in high-risk patients.
PATIENTS AND METHODS:
In a multicenter, prospective, randomized controlled trial, 320 patients with ESCC were randomly
assigned to primary WLI followed by NBI (n = 162) or primary NBI followed by WLI (n = 158) in a
back-to-back fashion. The primary aim was to compare the real-time detection rates of superficial
cancer in the H&N region and the esophagus between WLI and NBI. The secondary aim was to
evaluate the diagnostic accuracy of these techniques.
RESULTS:
NBI detected superficial cancer more frequently than did WLI in both the H&N region and the
esophagus (100% v 8%, P < .001; 97% v 55%, P < .001, respectively). The sensitivity of NBI for
diagnosis of superficial cancer was 100% and 97.2% in the H&N region and the esophagus,
respectively. The accuracy of NBI for diagnosis of superficial cancer was 86.7% and 88.9% in these
regions, respectively. The sensitivity and accuracy were significantly higher using NBI than WLI in
both regions (P < .001 and P = .02 for the H&N region; P < .001 for both measures for the esophagus,
respectively).
CONCLUSION:
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NBI could be the standard examination for the early detection of superficial cancer in the H&N region
and the esophagus.
8- Laryngoscope. 2008 Apr;118(4):671-5.
Identification of distant metastases with positron-emission tomography-computed
tomography in patients with previously untreated head and neck cancer.
Gourin CG, Watts TL, Williams HT, Patel VS, Bilodeau PA, Coleman TA.
Source
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta,
Georgia, USA. [email protected]
Abstract
OBJECTIVES:
To investigate the utility of positron-emission tomography-computed tomography (PET-CT) in
identifying distant metastatic disease in patients with previously untreated head and neck squamous
cell cancer (HNSCC) prior to definitive treatment.
MATERIALS AND METHODS:
Retrospective analysis of 27 consecutive patients with previously untreated HNSCC who underwent
PET-CT imaging in addition to chest radiography (CXR) as part of their metastatic workup.
RESULTS:
The majority of patients (89%) had TNM stage III or IV disease. PET-CT was suspicious for
pulmonary malignancy in four (15%) patients and indeterminate in one (4%) patient. CXR was
suspicious for pulmonary malignancy in two (7%) patients. Pulmonary metastases or a new lung
primary was present in 3 (11%) patients: 3 of 4 (75%) patients with positive PET-CT scans and 0 of
23 (0%) patients with negative or indeterminate PET-CT scans compared with 2 of 2 (100%) patients
with positive CXR and 1 of 25 (4%) patients with negative CXR. The sensitivity and specificity of
PET-CT in predicting pulmonary malignancy was 100% and 96%, respectively, with a positive
predictive value of 75% and a negative predictive value of 100%. The sensitivity and specificity of
CXR in predicting pulmonary malignancy was 67% and 100%, respectively, with a positive predictive
value of 100% and a negative predictive value of 96%. Including nonpulmonary sites, the overall
incidence of distant metastatic disease was 19% (5/27) with 11% (3/27) unsuspected prior to PET-CT.
CONCLUSIONS:
PET-CT improves detection of metastatic disease in the high-risk patient and should be performed as
part of the routine pretreatment evaluation of patients with advanced stage HNSCC.
9- Kulak Burun Bogaz Ihtis Derg. 2007;17(6):324-8.
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Is PET superior to MRI in the pretherapeutic evaluation of head and neck squamous cell
carcinoma?
Minovi A, Hertel A, Ural A, Hofmann E, Draf W, Bockmuehl U.
Source
Department of Otolaryngology, Head and Neck and Facial Plastic Surgery, Klinikum Fulda gAG,
Teaching Hospital of the Philipps-University, Fulda, Germany.
Abstract
OBJECTIVES:
This study was designed to compare the effectiveness of positron emission tomography (PET) and
magnetic resonance imaging (MRI) in the pretherapeutic staging of squamous cell carcinoma (SCC) of
the head and neck.
PATIENTS AND METHODS:
The study included 34 consecutive patients (27 males, 7 females; mean age 61 years; range 42 to 82
years) with SCC of the head and neck. All the patients underwent whole body
[18F]fluorodeoxyglucose (FDG)-PET and MRI scans for pretherapeutic evaluation. Diagnoses were
confirmed by histopathologic examination of endoscopic biopsy specimens.
RESULTS:
The sites of the primary tumors were the oropharynx (n=15, 44%), larynx (n=10, 29%), hypopharynx
(n=8, 24%), and nasopharynx (n=1, 3%). Surgery was the treatment of choice in 20 patients (59%),
including 23 neck dissections. Fourteen patients (41%) were treated with radiochemotherapy. Both
PET and MRI were able to detect the primary tumor in 33 cases (97%). In two patients (6%), PET was
able to detect distant metastases in the lung and iliac bone, all of which were confirmed by biopsies.
Seven neck specimens (30%) showed lymph node metastasis. Sensitivity and specificity rates for
detection of lymph node metastasis were 100% and 87.5% for PET, and 85.7% and 87.5% for MRI,
respectively.
CONCLUSION:
Although PET seems to be superior to MRI in detecting nodal disease and distant metastases, it is still
early to recommend it as a primary tool for pretherapeutic evaluation of head and neck cancers due to
its limited availability and higher cost.
10- Clin Otolaryngol. 2008 Feb;33(1):47-51.
PET/CT for assessing mandibular invasion by intraoral squamous cell carcinomas.
Babin E, Desmonts C, Hamon M, Bénateau H, Hitier M.
Abstract
Evaluation of mandible invasion in cancer of the oral cavity and oropharynx is a major challenge.
Today, CT scans are the most frequent imaging technique used, with sensitivity of 53 to 92% and
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specificity of 83 to 96%. Positron emission tomography is known as one of the most sensitive imaging
techniques for head and neck cancer, but has poor anatomical resolution. Our study associates positron
emission tomography with CT scans, fusioning both images to maximise data information. Positron
emission tomography/CT fusion shows sensitivity of 100% with specificity of 85%. This result
encourages the use of positron emission tomography/CT when assessing mandibular invasion.
11- Br J Oral Maxillofac Surg. 2005 Feb;43(1):1-6.
Positron emission tomography in cancer of the head and neck.
Hain SF.
Source
The Institute of Nuclear Medicine, Middlesex Hospital, UCH NHS Trust and Charing Cross Hospital,
Hammersmith Hospitals NHS Trust, London W1T 3AA, UK. [email protected]
Abstract
The use of positron emission tomography (PET) has increased in oncology and in the assessment of
head and neck tumours, where it is most useful for recurrent disease. It has good sensitivity and
specificity for diagnosis and staging but is generally not necessary except in difficult cases.
Quantitative measures of uptake on PET at diagnosis and after treatment do seem to have prognostic
value independent of other information about the tumour and so PET may influence management. It
also has a role in the identification of an unknown primary site and of synchronous primaries and
metastases (often missed by other imaging). Fusion imaging with magnetic resonance (MRI) or
computed tomography (CT) adds a new dimension with improved value for each technique.
12- Head Neck. 2009 Feb;31(2):189-94.
Prospective study of early detection of pharyngeal superficial carcinoma with the
narrowband imaging laryngoscope.
Ugumori T, Muto M, Hayashi R, Hayashi T, Kishimoto S.
Source
Division of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha
Kashiwa-city, Chiba 277-8577, Japan. [email protected]
Abstract
BACKGROUND:
The newly developed narrowband imaging (NBI) gastrointestinal endoscope makes possible the
detection of superficial carcinoma in the oropharynx and hypopharynx, which is difficult with the
conventional laryngoscope. Here, we investigated whether the combined use of laryngoscope with
NBI allows the detection of superficial carcinoma in this region.
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METHODS:
A total of 51 superficial, histologically confirmed lesions in 29 patients were studied. The quality of
visualization of superficial carcinoma in the oropharynx and hypopharynx using the NBI-equipped
laryngoscope was evaluated in comparison with the results by conventional laryngoscopy.
RESULTS:
The NBI laryngoscope provided better detection of the irregular microvascular pattern of carcinoma
than the conventional laryngoscope (p <.05) and better visualization of the demarcation line (p <.05),
and thus significantly better visualization of the lesions.
CONCLUSION:
The NBI laryngoscope may play an important role in the diagnosis and treatment of superficial
carcinoma in the oropharynx and hypopharynx.
PMID:
18853451
[PubMed - indexed for MEDLINE]
13- Head Neck Oncol. 2010 Oct 5;2:26.
Raman spectroscopy in head and neck cancer.
Harris AT, Rennie A, Waqar-Uddin H, Wheatley SR, Ghosh SK, Martin-Hirsch DP, Fisher SE, High AS,
Kirkham J, Upile T.
Source
Department of Ear, Nose and Throat/Head and Neck Surgery, Calderdale and Huddersfield NHS
Trust, Huddersfield UK. [email protected]
Abstract
In recent years there has been much interest in the use of optical diagnostics in cancer detection. Early
diagnosis of cancer affords early intervention and greatest chance of cure. Raman spectroscopy is
based on the interaction of photons with the target material producing a highly detailed biochemical
'fingerprint' of the sample. It can be appreciated that such a sensitive biochemical detection system
could confer diagnostic benefit in a clinical setting. Raman has been used successfully in key health
areas such as cardiovascular diseases, and dental care but there is a paucity of literature on Raman
spectroscopy in Head and Neck cancer. Following the introduction of health care targets for cancer,
and with an ever-aging population the need for rapid cancer detection has never been greater. Raman
spectroscopy could confer great patient benefit with early, rapid and accurate diagnosis. This
technique is almost labour free without the need for sample preparation. It could reduce the need for
whole pathological specimen examination, in theatre it could help to determine margin status, and
finally peripheral blood diagnosis may be an achievable target.
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14- AJR Am J Roentgenol. 2008 Mar;190(3):785-9.
Thin-slice MDCT of the neck: impact on cancer staging.
Lell MM, Gmelin C, Panknin C, Eckel KT, Schmid M, Bautz WA, Greess H.
Source
Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Peter V. Ueberroth
Bldg., Ste. 3371, 10945 LeConte Ave., Los Angeles, CA 90095, USA. [email protected]
Abstract
OBJECTIVE:
The objective of this study was to compare thin-slice multiplanar evaluation and conventional 3-mm
axial evaluation of head and neck MDCT in tumor staging.
MATERIALS AND METHODS:
Ninety-six patients with histologically proven squamous cell carcinoma were evaluated independently,
once using 3-mm axial images and once using 1-mm interactive multiplanar reformation (MPR)
images. Tumor stage was assessed with both methods; histology served as the reference. Thirty-seven
patients with hypopharyngeal and laryngeal tumors had en bloc resection, allowing direct comparison
of tumor infiltration into designated anatomic structures. Two examiners independently assessed the
data sets. Interobserver agreement was tested with a modified kappa test. The Wilcoxon signed rank
test with continuity correction was applied to test the null hypothesis, which postulates the equality of
both methods. The chi-square test was applied to compare the number of correctly classified tumors
for the two methods and readers.
RESULTS:
Interobserver agreement was high (kappa = 0.88-0.91). Both methods allowed accurate tumor staging,
and no significant differences between the two methods were found (reader A, p = 0.61; reader B, p =
1). With MPR assessment, more anatomic structures were rated positive for tumor infiltration, but
diagnostic accuracy did not differ significantly in the subgroup of patients with histologic correlation
from en bloc resection.
CONCLUSION:
C
onventional 3-mm axial evaluation of head and neck MDCT proved to be sufficient in tumor staging.
15- Semin Nucl Med. 2005 Oct;35(4):214-9.
Update on 18F-fluorodeoxyglucose/positron emission tomography and positron emission
tomography/computed tomography imaging of squamous head and neck cancers.
Menda Y, Graham MM.
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Source
Department of Radiology, University of Iowa, Iowa City, IA 52242, USA. [email protected]
Abstract
This article summarizes the recent literature in (18)F-fluorodeoxyglucose/positron emission
tomography (FDG-PET) imaging of head and neck cancers and extends the previous review in this
area by Schöder and Yeung in the July 2004 issue of Seminars in Nuclear Medicine. Positron emission
tomography/computed tomography (PET-CT) imaging is now used widely but has not been
adequately evaluated for head and neck cancer. Its accuracy in initial staging is better than CT but may
be similar to magnetic resonance imaging. It is not sufficiently accurate in the N0 neck to rule out
nodal metastases but may be appropriate if sentinel node mapping is performed in patients with PET
studies showing no nodal disease. PET imaging is beginning to be used in radiotherapy treatment
planning, where it makes a significant difference by identifying malignant normal size nodes, extent of
viable tumor, and distant disease. PET continues to be useful in carcinoma of unknown primary in
identification of the primary site. Overall success is around 27% after all other modalities have failed.
FDG-PET is being used frequently to assess response to therapy and for surveillance thereafter. The
major controversy is when to image after radiotherapy or combined chemo-radiotherapy. One month
seems to be too early. The ideal time seems to be 3 to 4 months to avoid both false-positive and falsenegative studies. The growing use of PET-CT studies in head and neck cancer will certainly make a
significant difference in the treatment and outcome in this disease.
PMID:
16150243
[PubMed - indexed for MEDLINE]
16- Jpn J Clin Oncol. 2010 Jun;40(6):537-41. Epub 2010 Feb 4.
Usefulness of narrow-band imaging for detecting the primary tumor site in patients with
primary unknown cervical lymph node metastasis.
Hayashi T, Muto M, Hayashi R, Minashi K, Yano T, Kishimoto S, Ebihara S.
Source
Department of Head and Neck Surgery, Kyoundo Hospital Sasaki Foundation, Tokyo, Japan.
[email protected]
Abstract
OBJECTIVE:
We sometimes experienced patients with primary unknown cervical lymph node metastasis. In such
cases, if computed tomography, magnetic resonance imaging, laryngoscopy and gastrointestinal
endoscopy cannot detect a primary site, there is no other effective method to identify a possible
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primary tumor. We investigated whether narrow-band imaging can detect a possible primary tumor in
such.
METHODS:
Forty-six patients with primary unknown cervical lymph node metastasis were surveyed about primary
tumors, from January 2003 to December 2006. All cervical lymph nodes were histologically proved to
be squamous cell carcinoma by fine-needle aspiration cytology. Narrow-band imaging combined with
magnifying endoscopy was used to identify the primary site in the head and neck region and cervical
esophagus. Histological analysis was performed for all suspicious lesions by a biopsy specimen.
RESULTS:
Twenty-six lesions were suspected to be cancerous lesions by narrow-band imaging in the head and
neck region. Sixteen lesions in 16 (35%, 16/46) patients were squamous cell carcinoma. Ten lesions
were located in the hypopharynx and the remaining six lesions were located in the oropharynx. White
light endoscopy could not point out any lesion.
CONCLUSIONS:
Narrow-band imaging endoscopy can detect possible primary cancer in patients with primary
unknown cervical lymph node metastasis.
17- ORL J Otorhinolaryngol Relat Spec. 2007;69(3):172-5. Epub 2007 Feb 5.
What is important for ultrasound evaluation of occult metastatic lymph nodes in
laryngeal cancer: size, shape, vascularity or cytological findings?
Cvorović L, Milutinović Z, Strbac M, Markovski S.
Source
Department of Otorhinolaryngology, University Hospital Zemun, Belgrade, Serbia.
[email protected]
Abstract
The assessment of the status of the cervical lymph nodes in patients with a squamous cell carcinoma
of the head and neck is still one of the most challenging diagnostic problems. We evaluated
ultrasonography criteria with respect to their value for comparative determination of occult metastatic
lymph nodes in laryngeal carcinoma. A prospective study was performed in 60 patients with laryngeal
squamous cell carcinoma without enlarged neck nodes on CT scan. We used recommended
sonography criteria for size, shape and vascularity for distinguishing metastatic and nonmetastatic
nodes preoperatively and compared them with cytological and histopathological investigations. Fiftytwo of 144 lymph nodes were involved with metastasis on histopathological examination. Respective
values for ultrasound-guided fine needle aspiration cytology (USg FNAC) showed high sensitivity,
specificity, positive and negative predictive values and accuracy (92, 100, 100, 96, and 97%,
respectively). The size, shape and vascularity showed significantly lower values of these statistic
parameters. USg FNAC is useful for preoperative evaluation of the neck, as the most reliable,
inexpensive and easily available method. It is essential for diagnosis, staging and therapy choices.
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Copyright (c) 2007 S. Karger AG, Basel.
18- Detection of lymph node metastases in head and neck cancer: A meta-analysis
comparing US, USgFNAC, CT and MR imaging Review Article
European Journal of Radiology, Volume 64, Issue 2, November 2007, Pages 266-272
R.B.J. de Bondt, P.J. Nelemans, P.A.M. Hofman, J.W. Casselman, B. Kremer, J.M.A. van
Engelshoven, R.G.H. Beets-Tan
Abstract
Purpose
To perform a meta-analysis comparing ultrasonography (US), US guided fine needle aspiration
cytology (USgFNAC), computed tomography (CT), and magnetic resonance imaging (MRI) in the
detection of lymph node metastases in head and neck cancer.
Methods
MEDLINE, EMBASE and Cochrane databases were searched (January 1990–January 2006) for
studies reporting diagnostic performances of US, USgFNAC, CT, and MRI to detect cervical lymph
node metastases. Two reviewers screened text and reference lists of potentially eligible articles.
Criteria for study inclusion: (1) histopathology was the reference standard, (2) primary tumors and
metastases were squamous cell carcinoma and (3) data were available to construct 2 × 2 contingency
tables. Meta-analysis of pairs of sensitivity and specificity was performed using bivariate analysis.
Summary estimates for diagnostic performance used were sensitivity, specificity, diagnostic odds
ratios (DOR) (95% confidence intervals) and summary receiver operating characteristics (SROC)
curves.
Results
From seventeen articles, 25 data sets could be retrieved. Eleven articles studied one modality: US
(n = 4); USgFNAC (n = 1); CT (n = 3); MRI (n = 3). Six articles studied two or more modalities: US
and CT (n = 2); USgFNAC and CT (n = 1); CT and MRI (n = 1); MRI and MRI-USPIO (Sinerem®)
(n = 2); US, USgFNAC, CT and MRI (n = 1). USgFNAC (AUC = 0.98) and US (AUC = 0.95) showed
the highest areas under the curve (AUC). MRI-USPIO (AUC = 0.89) and CT (AUC = 0.88) had
similar results. MRI showed an AUC = 0.79. USgFNAC showed the highest DOR (DOR = 260)
compared to US (DOR = 40), MRI-USPIO (DOR = 21), CT (DOR = 14) and MRI (DOR = 7).
Conclusion USgFNAC showed to be the most accurate imaging modality to detect cervical lymph
node metast
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19- What Does PET Imaging Add to Conventional Staging of Head and Neck Cancer
Patients? Original Research Article
International Journal of Radiation Oncology*Biology*Physics, Volume 68, Issue 2, 1 June
2007, Pages 383-387
Surjeet Pohar, Robert Brown, Nancy Newman, Michael Koniarczyk, Jack Hsu, David Feiglin
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Abstract | Figures/Tables | References
Purpose: To determine the value of PET scans in the staging of patients with head and neck
carcinoma.
Methods and Materials: The charts of 25 patients who underwent neck dissection, computed
tomography (CT) scan, and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET)
imaging as part of their initial work-up for a head and neck squamous cell cancer between 2000–2003
were reviewed. All patients underwent clinical examination, triple endoscopy, and chest radiograph as
part of their clinical staging, adhering to American Joint Commission for Cancer criteria. In addition
to the clinical nodal (N) stage, PET findings were incorporated to determine a second type of N
staging: clinical N + PET stage. The number of neck sides and nodal levels involved on CT or PET
and on pathologic examination were recorded.
Results: The sensitivity and specificity for detection of nodal disease were similar for CT and FDGPET. Positive and negative likelihood ratios were similar for both diagnostic tests. None of our 25
patients had unsuspected distant disease detected by PET.
Conclusion: The addition of PET imaging did not improve diagnostic accuracy in our patients
compared with CT. PET scanning did not alter clinical management in any of the patients.
20- The value of 18F-FDG PET/CT for the detection of distant metastases in high-risk patients
with head and neck squamous cell carcinoma Original Research Article
Oral Oncology, In Press, Corrected Proof, Available online 11 June 2011
Stephan K. Haerle, D.T. Schmid, N. Ahmad, T.F. Hany, S.J. Stoeckli
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Abstract
Summary
The aims of this study were to assess a cohort of patients with head and neck squamous cell
carcinoma (HNSCC) for: (1) the prevalence of synchronous distant metastases (DM) as detected by
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the initial staging by using 18F-FDG PET/CT, (2) the prevalence of metachronous DM, and (3) the
validity of published risk factors with special emphasis on the maximum standardized uptake value
(SUV max) for the prediction of DM. Two hundred and ninety nine patients with advanced HNSCC
were included. Following risk factors at the time of diagnosis and during follow-up were analyzed:
advanced T/N stage, poor histological differentiation, level IV/Vb lymph nodes, primary site in the
larynx/hypopharynx, and SUV max. The prevalence of DM at initial staging and during follow-up was
10% and 11%, respectively. At initial staging, primary site in the larynx/hypopharynx and neck nodes
in level IV/Vb, and during follow-up only level IV/Vb nodes achieved statistical significance. The
sensitivity for 18F-FDG PET/CT with regard to the detection of DM was 96.8%, the specificity 95.4%,
the positive predictive value (PV) 69.8%, and the negative PV 99.6%. Patients without DM showed a
significantly better overall survival (OS) than patients developing DM (p < 0.001). There was no
significant difference in OS with regard to the time of diagnosis of DM. The prevalence for
synchronous and metachronous DM in advanced HNSCC is considerable. 18F-FDG PET/CT is highly
accurate for initial staging and follow-up. DM carries a bad prognosis regardless of the time of
diagnosis.
21- PET-MRI Fusion in Head-and-Neck Oncology: Current Status and Implications for Hybrid
PET/MRI Original Research Article
Journal of Oral and Maxillofacial Surgery, In Press, Corrected Proof, Available online 20
May 2011
Denys J. Loeffelbein, Michael Souvatzoglou, Veronika Wankerl, Axel Martinez-Möller, Julia
Dinges, Markus Schwaiger, Ambros J. Beer
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Abstract | Figures/Tables | References
Positron emission tomography (PET) with [18F]-fluorodeoxyglucose has shown promising results in
the staging of head-and-neck cancer, especially for the assessment of lymph node involvement,
identification of distant metastasis and synchronous and metachronous tumors, and evaluation of
tumor recurrence or carcinoma of an unknown primary. Additionally, many tracers provide
information on tumor biology and physiology, such as tissue hypoxia. For morphologic imaging,
magnetic resonance imaging (MRI) has several advantages compared with computed tomography in
the head-and-neck area. This is mainly because of the superior soft tissue contrast and fewer
artifacts from dental implants. Moreover, MRI allows for functional imaging, such as the assessment
of perfusion with dynamic contrast-enhanced MRI. Thus, the combination of the excellent anatomic
and functional imaging capabilities of MRI and the potential for molecular and metabolic imaging
using PET could be of synergistic value. The published data indicate that image fusion should be
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beneficial in the case of recurrence of oromaxillofacial cancer or in the evaluation of potential
metastatic lymph nodes. However, retrospective image fusion is technically demanding in the headand-neck area, mainly because of the varied patient positions used for the various scanners and the
anatomic complexity of this region. Combined PET/MRI scanners might overcome these problems.
Both sequential and fully integrated PET/MRI scanners have already been installed, and future
studies will show whether hybrid PET/MRI is of greater clinical value than PET/computed
tomography and retrospective image fusion techniques. In the present review, we discuss the clinical
effect and current status of PET-MRI image fusion for imaging in head-and-neck cancer and its
implications for imaging with future hybrid PET/MRI scanners.
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