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A Journal on Nuclear Medicine and Molecular Imaging
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2015 September;59(3):327-35

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Detection of extranodal spread in head and neck cancer with [18F]FDG PET and MRI: improved accuracy?

Lodder W. L. 1, Vogel W. V. 2, Lange C. A. 3, Hamming-Vrieze O. 4, Van Velthuysen M.-L. 5, Pameijer F. A. 6, Balm A. J. 1, 7, Van Den Brekel M. W. 1, 7, 8

1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands;
2 Department of Nuclear Medicine, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;
3 Department of Radiology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;
4 Department of Radiotherapy, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;
5 Department of Pathology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;
6 Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands;
7 Department of Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands;
8 Institute of Phonetic Sciences, ACLC, University of Amsterdam, Amsterdam, The Netherlands


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AIM: Preoperative detection of extranodal spread (ENS) in head and neck cancer can have important consequences for patient management. The aim of this study was to determine whether 18-fluorodeoxyglucose positron emission tomography ([18F]FDG PET) or a combination with Magnetic Resonance Imaging (MRI) could more accurately predict ENS, especially with the near availability of fully integrated [18F]FDG PET/MRI scanners.
METHODS: In retrospective cohort design a total of twelve patients, with 18 lymphnode metastases were studied with [18F]FDG PET and MRI. Presence of ENS was scored on MRI, and [18F]FDG PET images using a SUV max cut-off point of 12. Histopathology results were used as reference standard. Sensitivity, specificity and accuracy were calculated.
RESULTS: The sensitivity, specificity and accuracy of [18F]FDG PET for ENS reached 70%,100% and 83%, respectively. The mean SUVmax of ENS positive lymphnodes was 13.6 versus 8.7 for lymphnode metastases without ENS (P=0.03). The sensitivity, specificity and accuracy of MRI for ENS were 70%, 100% and 83%, respectively. When the [18F]FDG PET and MRI findings were combined sensitivity, specificity and accuracy were 80%, 100% and 89%, respectively. Thus, accuracy increased from 83% to 89%.
CONCLUSION: When there is no ENS or doubt of ENS on MRI, [18F]FDG PET seems to have additional value since it improves sensitivity and resolves uncertainty in case of high FDG uptake. This benefit needs to be confirmed prospectively in a larger cohort.

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w.l.lodder@umcg.nl