¹⁸F-FDG PET for detecting metastases and synchronous primary malignancies in patients with oral and oropharyngeal cancer

Summary

Aim: Assessment of the efficiency of ¹⁸F-FDGPET (PET) for the detection of distant metastases and synchronous primary malignancies in patients with oral and oropharyngeal squamous cell cancer (OOSCC). Patients, methods: Retrospective evaluation of PET studies of 422 patients with histologically confirmed OOSCC. 99 patients (23.5%) demonstrated a suspect distant finding of whom 84 could be interdisciplinary evaluated and consecutively confirmed or refuted by other diagnostic modalities or biopsy. Results: In 74 of 80 evaluable cases, PET showed the primary tumour (92.5%). 26/84 suspect distant lesions (31%) showed by means of PET were confirmed to be malignancies (mean SUV 3.96; range 1.4-9.37). Main sites were the lung, the upper aerodigestive tract, and the gastrointestinal system. In the other 58 cases (69%), where the suspect lesions were confirmed as benign, mean SUV was 2.65 (range 0.7–6.5) (difference statistically significant). The SUV above which every suspect finding was proven to be of malignant condition was 6.5 (specificity 100%, sensitivity 38%, accuracy 81%). Conclusion: PET may have an important role in initial staging and the detection of distant metastases and synchronous primary malignancies. Setting a SUV threshold for determining malignancies can support interpretation. In borderline cases, however, interdisciplinary evaluation by means of other diagnostic modalities remains crucial.

Zusammenfassung

Ziel: Untersuchung der Effektivität der ¹⁸F-FDGPET (PET) zum Nachweis von Fernmetastasen und Zweitmalignomen bei Patienten mit einem Plattenepithelkarzinom der Mundhöhle und des Oropharynx. Patienten, Methoden: Retrospektive Beurteilung von PET-Untersuchungen bei 422 Patienten mit einem histologisch bestätigten Plattenepithelkarzinom der Mundhöhle und des Oropharynx. 99 Patienten (23,5%) zeigten verdächtige Befunde außerhalb des Primarius, von denen 84 interdisziplinär untersucht und durch weiterführende Diagnostik oder Biopsien verifiziert oder widerlegt werden konnten. Ergebnisse: Bei 74 von 80 auswertbaren Patienten bestätigte die PET die Primärtumore (92,5%). Bei 26/84 (31%) der in der PET verdächtigen Befunde außerhalb des Primarius konnten Malignome bestätigt werden (SUV durchschnittlich 3,96; Bereich 1,4–9,37). Hauptlokalisationen waren Lunge, oberer Aerodigestivtrakt und gastrointestinales System. 58/84 der verdächtigen Befunde stellten sich als gutartige Geschehen dar (69%) mit einem SUV-Durchschnitt von 2,65 (Bereich 0,7–6,5) (Unterschied statistisch signifikant). Der SUV, oberhalb dessen der Nachweis eines verdächtigen Befundes immer positiv auf Malignität war, war 6,5 (Spezifität 100%, Sensitivität 38%, Genauigkeit 81%). Schlussfolgerung: Die PET kann eine wichtige Funktion bei dem initialen Staging und bei der Detektion von Fernmetastasen und Zweitmalignomen übernehmen. Das Aufstellen einer SUV-Grenze zur Bestimmung von Malignitäten kann die Interpretation unterstützen. In Grenzfällen jedoch bleibt die Bestätigung durch weiterführende Diagnostik entscheidend.

Keywords

¹⁸F-FDG PET - oral and oropharyngeal squamous cell cancer - distant metastases - synchronous primary malignancies - standard uptake value

Schlüsselwörter

¹⁸F-FDG-PET - Plattenepithelkarzinome der Mundhöhle und des Oropharynx - Fernmetastasen - Zweitmalignome - SUV

• References

• 1 Antoch G, Stattaus J, Nemat AT. et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 2003; 229: 526-533.
• 2 Bar-Sever Z, Keidar Z, Ben-Barak A. et al. The incremental value of ¹⁸F-FDG PET/CT in paediatric malignancies. Eur J Nucl Med Mol Imaging 2007; 34: 630-637.
• 3 Brouwer J, Senft A, de Bree R. et al. Screening for distant metastases in patients with head and neck cancer: is there a role for ¹⁸FDG-PET?. Oral Oncol 2006; 42: 275-280.
• 4 Buckley JG, Ferlito A, Shaha AR, Rinaldo A. The treatment of distant metastases in head and neck cancer--present and future. ORL J Otorhinolaryn- gol Relat Spec 2001; 63: 259-264.
• 5 Döbert N, Hamscho N, Menzel C. et al. Limitations of dual time point FDG-PET imaging in the evaluation of focal abdominal lesions. Nuklearmedizin 2004; 43: 143-149.
• 6 Ferlito A, Shaha AR, Silver CE. et al. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001; 63: 202-207.
• 7 Goerres GW, Schmid DT, Gratz KW. et al. Impact of whole body positron emission tomography on initial staging and therapy in patients with squamous cell carcinoma of the oral cavity. Oral Oncol 2003; 39: 547-551.
• 8 Goerres GW, Stoeckli SJ, von Schulthess GK, Steinert HC. FDG PET for mucosal malignant melanoma of the head and neck. Laryngoscope 2002; 112: 381-385.
• 9 Haberkorn U, Strauss LG, Reisser C. et al. Glucose uptake, perfusion, and cell proliferation in head and neck tumors: relation of positron emission tomography to flow cytometry. J Nucl Med 1991; 32: 1548-1555.
• 10 Keyes Jr JW. SUV: standard uptake or silly useless value?. J Nucl Med 1995; 36: 1836-1839.
• 11 Kim SY, Roh JL, Kim JS. et al. Utility of FDG PET in patients with squamous cell carcinomas of the oral cavity. Eur J Surg Oncol 2008; 34: 208-215.
• 12 Kitagawa Y, Nishizawa S, Sano K. et al. Whole-body ¹⁸F-fluorodeoxyglucose positron emission tomography in patients with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 202-207.
• 13 Kitagawa Y, Sano K, Nishizawa S. et al. FDG-PET for prediction of tumour aggressiveness and response to intra-arterial chemotherapy and radiotherapy in head and neck cancer. Eur J Nucl Med Mol Imaging 2003; 30: 63-71.
• 14 Krabbe CA, Pruim J, van der Laan BF. et al. FDG- PET and detection of distant metastases and simultaneous tumors in head and neck squamous cell carcinoma: A comparison with chest radiography and chest CT. Oral Oncol 2009; 45: 234-240.
• 15 Krause BJ, Beyer T, Bockisch A. et al. FDG-PET/CT in oncology. German Guideline. Nuklearmedizin 2007; 46: 291-301.
• 16 Kunkel M, Helisch A, Reichert TE. et al. Clinical and prognostic value of [¹⁸F]FDG-PET for surveillance of oral squamous cell carcinoma after surgical salvage therapy. Oral Oncol 2006; 42: 297-305.
• 17 Kunkel M, Wahlmann U, Grötz KA. et al. Value of ¹⁸F-2-fluorodeoxyglucose PET scanning in staging mouth cavity carcinoma. Comparative evaluation of PET findings before and after preoperative radiochemotherapy with histological and computerized tomography findings. Mund Kiefer Ge- sichtschir 1998; 2: 181-187.
• 18 Layland MK, Sessions DG, Lenox J. The influence of lymph node metastasis in the treatment of squa- mous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+. Laryngoscope 2005; 115: 629-639.
• 19 Leon X, Ferlito A, Myer 3rd CM. et al. Second primary tumors in head and neck cancer patients. Acta Otolaryngol 2002; 122: 765-778.
• 20 Leon X, Quer M, Orus C. et al. Distant metastases in head and neck cancer patients who achieved loco- regional control. Head Neck 2000; 22: 680-686.
• 21 McGuirt WF, Greven K, Williams 3rd D. et al. PET scanning in head and neck oncology: a review. Head Neck 1998; 20: 208-215.
• 22 Pauls S, Buck AK, Hohl K. et al. Improved non-invasive T-Staging in non-small cell lung cancer by integrated ¹⁸F-FDG PET/CT. Nuklearmedizin 2007; 46: 9-14.
• 23 Schmid DT, Stoeckli SJ, Bandhauer F. et al. Impact of positron emission tomography on the initial staging and therapy in locoregional advanced squa- mous cell carcinoma of the head and neck. Laryngoscope 2003; 113: 888-891.
• 24 Schmidt M, Schmalenbach M, Jungehulsing M. et al. ¹⁸F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases. Comparison of qualitative visual and semiquantitative analysis. Nuklearmedizin 2004; 43: 91-101.
• 25 Schwager K, Nebel A, Baier G, Hoppe F. Second primary carcinomas in the upper aerodigestive tract in different locations and age groups. Laryngorhinoo- tologie 2000; 79: 599-603.
• 26 Sobin LH, Fleming ID. TNM Classification of Malignant Tumors. Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer 1997; 80: 1803-1804.
• 27 Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med 2007; 48: 932-945.
• 28 Stergar H, Bockisch A, Eschmann SM. et al. Influence of PET/CT-introduction on PET scanning frequency and indications. Results of a multicenter study. Nuklearmedizin 2007; 46: 57-64.
• 29 Stuckensen T, Kovacs AF, Adams S, Baum RP. Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 2000; 28: 319-324.
• 30 Suzuki H, Hasegawa Y, Terada A. et al. FDG-PET predicts survival and distant metastasis in oral squamous cell carcinoma. Oral Oncol. 2008 doi 10.1016/j.oraloncology.2008.07.009.
• 31 Tepperman BS, Fitzpatrick PJ. Second respiratory and upper digestive tract cancers after oral cancer. Lancet 1981; 2 (8246) 547-549.
• 32 WHO. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. 2006
• 33 Wong RJ, Lin DT, Schoder H. et al. Diagnostic and prognostic value of [¹⁸F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol 2002; 20: 4199-4208.
• 34 Woolgar JA, Rogers S, West CR. et al. Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection. Oral Oncol 1999; 35: 257-265.