Subscribe to RSS
DOI: 10.1055/s-2002-32215
© Georg Thieme Verlag Stuttgart · New York
Korrelation von FDG-PET und MRT/CT mit der Histopathologie in Primärdiagnostik, Lymphknotenstaging und Rezidivdiagnostik von Kopf-Hals-Tumoren
Correlation of FDG-PET and MRI/CT with histopathology in primary diagnosis, lymph node staging and diagnosis of recurrency of head and neck cancerPublication History
Publication Date:
13 June 2002 (online)
![](https://www.thieme-connect.de/media/roefo/200206/lookinside/thumbnails/10.1055-s-2002-32215-1.jpg)
Zusammenfassung
Ziel: Ein korrektes Staging von Kopf-Hals-Tumoren ist entscheidend für die Prognose der Patienten und das weitere therapeutische Vorgehen. Ziel der vorliegenden Studie war es, die Wertigkeit der FDG-PET bezüglich präoperativer Primärdiagnostik, zervikalem Lymphknoten-Staging, Rezidivdiagnostik und Primariussuche bei zervikalen Lymphknotenmetastasen zu überprüfen, die Ergebnisse mit der morphologischen Bildgebung (CT/MRT) zu vergleichen und beide Verfahren mit der Histopathologie zu korrelieren. Patienten/Methodik: 115 Patienten wurden mittels FDG-PET (ECAT EXACT HR+) und CT bzw. MRT untersucht (72 × Primärdiagnostik, 37 × Rezidivdiagnostik und 6 × Primariussuche). Die Befunde wurden mit den Ergebnissen der Histopathologie bezüglich Primär- bzw. Rezidivtumor und Lymphknotenstatus korreliert. Ergebnisse: In der Primärdiagnostik ergab sich für den Nachweis des Primarius eine Sensitivität und Spezifität von 85 % bzw. 100 % für die PET und 88 % bzw. 75 % für CT/MRT. Die Treffsicherheit lag bei 86 % für die PET und 87 % für CT/MRT. Für das primäre Lymphknotenstaging berechnete sich die Sensitivität und Spezifität zu 71 % bzw. 86 % für die PET und zu 74 % bzw. 57 % für CT/MRT. Die Treffsicherheit lag bei 77 % für die PET bzw. 68 % für die morphologische Bildgebung. In 23 Fällen lagen pT1-Tumoren mit Durchmessern < 12 mm vor, welche dem Nachweis durch CT/MRT in 8 Fällen bzw. durch PET in 10 Fällen entgingen. Bezüglich der Rezidivdiagnostik (n = 37) ergaben sich sowohl für die Sensitivität (83 %), die Spezifität (76 %) als auch die Treffsicherheit (78 %) höhere Werte für die PET im Vergleich zu CT/MRT (Sensitivität: 67 %; Spezifität: 52 %; Treffsicherheit: 57 %). Bei 4/6 Patienten mit CUP-Syndrom konnte ein Primarius anhand der Bildgebung gefunden werden (3/4 mittels PET, 2/4 mittels CT/MRT), bei 2/6 Patienten konnte auch im weiteren klinischen Verlauf kein Primärtumor nachgewiesen werden. Schlussfolgerung: Während die FDG-PET in der Primärtumordiagnostik nur einen marginalen diagnostischen Zugewinn zur morphologischen Bildgebung aufweist, zeigt sich hinsichtlich des Lymphknoten-Stagings bei gleicher Sensitivität eine höhere Spezifität. In der Diagnostik des Lokalrezidivs und in der Primariussuche bei CUP-Syndrom scheint die PET der CT/MRT überlegen.
Abstract
Aim: Correct staging of head and neck cancer is important for the patient's prognosis and further therapeutic strategies. Aim of the present study was to investigate the diagnostic value of FDG-PET regarding the pre-surgical diagnosis of primary tumor and cervical lymph node metastases, the diagnosis of tumour recurrence, and the localisation of unknown primary, further to compare the results to those of morphological imaging modalities (CT/MRI) and to correlate the results of both methods with histopathological findings. Patients/Methods: 115 patients (pts) (72 × primary diagnosis, 37 × recurrence, and 6 × unknown primary) underwent FDG-PET (ECAT EXACT HR+) and CT or MRI. Results were correlated with histopathological findings in terms of detection of primary and recurrent tumors as well as lymph node metastases. Results: Regarding the pre-surgical diagnosis, sensitivity and specificity for identifying primary tumors were 85 % and 100 % for PET and 88 % and 75 % for CT/MRI, respectively. Accuracy was 86 % for PET and 87 % for CT/MRI. Sensitivity and specificity for detecting primary lymph node envolvement were 71 %/86 % for PET and 74 %/57 % for CT/MRI, resulting in an accuracy of 77 % with PET and 68 % with morphological imaging. In 23 pts histopathology revealed pT1 stages with tumor diameters < 12 mm. In 8 pts CT/MRI and in 10 pts PET failed to identify these small primary lesions. Detecting tumor recurrence (n = 37) PET showed a higher sensitivity (83 %), specificity (76 %) and accuracy (78 %) compared to CT/MRI (sensitivity: 67 %; specificity: 52 %; accuracy: 57 %). In 4/6 pts with unknown primary, imaging was able to identify a primary lesion (3/4 in FDG-PET, 2/4 in CT/MRI), in 2/6 patients even in the follow-up no primary tumor was found. Conclusions: FDG-PET provides only minor additional information to morphological imaging concerning diagnosis of primary tumors. At a similar level of sensitivity, however, it seems to be more specific regarding the lymph node involvement. PET seems to be superior to CT/MRI in detecting tumor recurrence as well as occult primary tumors in pts with known cervical lymph node metastases.
Schlüsselwörter
HNO-Tumoren - FDG-PET - CT - MRT - CUP
Key words
Head and neck cancer - FDG-PET - CT - MRI - Cancer of unknown primary
Literatur
- 1 Spitz M R. Epidemiology and risk factors for head and neck cancer. Sem Oncol. 1994; 21 281-288
- 2 Landis S H, Murray T, Bolden S, Wingo P A. Cancer Statistics 1999. CA Cancer J Clin. 1999; 49 8-31
- 3 Vokes E E, Weichselbaum R R, Lippmann S M, Hong W K. Head and neck cancer. N Engl J Med. 1993; 328 184-194
- 4 Rege S, Maass A, Chaiken L, Hoh C K, Choi Y, Lufkin R, Anzai Y, Juillard G, Maddahi J, Phelps M E. Use of positron emission tomography with Fluorodeoxyglucose in patients with extracranial head and neck cancers. Cancer. 1994; 73 3047-3058
- 5 Minn H, Joensuu H, Ahonen A, Klemi P. Fluorodeoxyglucose imaging: A method to assess the proliferative activity of human cancer in vivo. Cancer. 1988; 61 1776-1781
- 6 Haberkorn U, Strauss L G, Reisser C, Haag D, Dimitrakopoulou A, Ziegler S, Oberdorfer F, Rudat V, van Kaick G. Glucose uptake, perfusion, and cell proliferation in head and neck tumors: Relation of positron emission tomography to flow cytometry. J Nucl Med. 1991; 32 1548-1554
- 7 Haberkorn U, Strauss L G, Reisser C, van Kaick G. Positron emission tomography (PET) for the evaluation of tumor proliferation and for therapy monitoring in head and neck tumors. Radiologe. 1992; 32 296-301
- 8 Reisser C, Eichhorn K, Herold-Mende C. Glucose uptake in malignant tumors of the head and neck. HNO. 1999; 47 712-717
- 9 Bailet J W, Abemayor E, Jabour B A, Hawkins R A, Ho C, Ward P H. Positron emission tomography: A new, precise imaging modality for detection of primary head and neck tumors and assessment of cervical adenopathy. Laryngoscope. 1992; 102 281-288
- 10 Jabour B A, Choi Y, Hoh C K, Rege S D, Soong J C, Lufkin R B, Hanafee W N, Maddahi J, Chaiken L, Bailet J, Phelps M E, Hawkins R A, Abemeyor E. Extracranial head and neck: PET imaging with 2-(F-18)Fluoro-2- Deoxy-D-Glucose and MR imaging correlation. Radiology. 1993; 196 27-35
- 11 Braams J W, Pruim J, Freling N J, Nikkels P G, Roodenburg J L, Boering G, Vaalburg W, Vermey A. Detection of lymph node metastases of squamous-cell cancer of the head and neck with (18F)-FDG-PET and MRI. J Nucl Med. 1995; 36 211-216
- 12 Laubenbacher C, Saumweber D, Wagner-Manslau C, Kau R J, Herz M, Avril N, Ziegler S, Kruschke C, Arnold W, Schwaiger M. Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med. 1995; 36 1747-1757
- 13 Adams S, Baum R P, Stuckensen T, Bitter K, Hör G. Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med. 1998; 25 1255-1260
- 14 McGuirt W F, Greven K, Williams D, Keyes J W, Watson N, Cappellari J O, Geisinger K R. PET scanning in head and neck oncology: a review. Head Neck. 1998; 20 208-215
- 15 Nowak B, Di Martina E, Jänicke S, Cremerius U, Adam G, Zimny M, Reinartz P, Büll U. Diagnostic evaluation of malignant head and neck cancer by F-18-FDG PET compared to CT/MRI. Nuklearmedizin. 1999; 38 312-318
- 16 Di Martino E, Nowak B, Krombach G A, Sellhaus B, Hausmann R, Cremerius U, Büll U, Westhofen M. Results of pretherapeutic lymph node diagnosis in head and neck cancer: Clinical value of 18F-Fluorodeoxglucose Positron Emission Tomography (PET). Laryngo-Rhino-Otol. 2000; 79 201-206
- 17 Kresnik E, Mikosch P, Gallowitsch H J, Kogler D, Wieser S, Heinisch M, Unterweger O, Raunik W, Kumnig G, Gomez I, Grünbacher G, Lind P. Evaluation of head and neck cancer with 18F-FDG PET: a comparison with conventional methods. Eur J Nucl Med. 2001; 28 816-821
- 18 Dresel S, Schwenzer K, Brinkbäumer K, Schmid R, Szeimies U, Pöpperl G, Hahn K. (F-18)FDG imaging of head and neck tumors: Comparison of hybrid PET, dedicated PET and CT. Nuklearmedizin. 2001; 40 172-178
- 19 Bailet J W, Sercarz J A, Abemayor E, Anzai Y, Lufkin R B, Hoh C K. The use of positron emission tomography for early detection of recurrent head and neck squamous cell carcinoma in postradiotherapy patients. Laryngoscope. 1995; 105 135-139
- 20 Slevin N J, Collins C D, Hastings D L, Waller M L, Johnson R J, Cowan R A, Birzgalis A R, Farrington W T, Swindell R. The diagnostic value of positron emission tomography (PET) with radiolabelled fluorodeoxyglucose (18F-FDG) in head and neck cancer. J Laryngol Otol. 1999; 113 548-554
- 21 Lapela M, Eigtved A, Jyrkkiö S, Grénman R, Kurki T, Lindhom P, Nuutinen J, Sutinen E, Solin O, Bjornskov I, Bretlau P, Friberg L, Hom S, Jensen M, Hansen H S, Minn H. Experience in qualitative und quantitative FDG PET in follow-up of patients with suspected recurrence from head and neck cancer. Eur J Cancer. 2000; 36 858-867
- 22 Braams J W, Pruim J, Kole A C, Nikkels P G, Vaalburg W, Vermey A, Roodenburg L J. Detection of unknown primary head and neck tumors by positron emission tomography. Int J Oral Maxillofac Surg. 1997; 26 112-115
- 23 Mendenhall W M, Mancuso A A, Parsons J T, Stringer S P, Cassisi N J. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck. 1998; 20 739-744
- 24 Ichiya Y, Kuwabara Y, Otsuka M, Tahara T, Yoshikai T, Fukumura T, Jingu K, Masuda K. Assessment of response to cancer therapy using Fluorine-18-Fluorodeoxyglucose and positron emission tomography. J Nucl Med. 1991; 32 1655-1660
- 25 Seifert E, Schadel A, Haberkorn U, Strauss L G. Use of positron emission tomography to evaluate the effectiveness of chemotherapy in patients with head and neck cancer. HNO. 1992; 40 90-93
- 26 Rege S, Chaiken L, Hoh C K, Choi Y, Lufkin R, Anzai Y, Juillard G, Maddahi J, Phelps M E, Hawkins R A. Change induced by radiation therapy in FDG uptake in normal and malignant structures of the head and neck: Quantitation with PET. Radiology. 1993; 189 807-812
- 27 Greven K M, Williams D W, Keyes J, McGuirt W F, Watson N E, Randall M E, Raben M, Geisinger K R, Cappellari J O. Positron emission tomography of patients with head and neck carcinoma before and after high dose irradiation. Cancer. 1994; 74 1355-1359
- 28 Kitagawa Y, Sadato N, Azuma H, Ogasawara T, Yoshida M, Ishii Y, Yonekura Y. FDG PET to evaluate combined intra-arterial chemotherapy and radiotherapy of head and neck neoplasms. J Nucl Med. 1999; 40 1132-1137
-
29 Myers E, Leffall L.
Head and neck oncology: Diagnosis, treatment and rehabilitation. Boston; Little Brown 1991 - 30 Wong W, Chevretton E, McGurk M, Hussain K, Davis J, Beaney R, Baddeley H, Tierney P, Maisey M. A prospective study of FDG-PET imaging for the assessment of head and neck squamous cell carcinoma. Clin Otolaryngol. 1997; 22 209-214
- 31 Greven K M, Keyes J W, Willams D W, McGuirt W F, Joyce W T. Occult primary tumors of the head and neck. Cancer. 1999; 86 114-118
Dr. med. Gabriele Pöpperl
Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität
München, Klinikum Großhadern
Marchioninistraße 15
81377 München
Phone: + 49-89-7095-4646
Fax: + 49-89-7095-7646
Email: gpoepper@nuk.med.uni-muenchen.de