Twyla Brianne Bartel DO, Presenter: Nothing to Disclose

Yusuf Menda MD, Abstract Co-Author: Nothing to Disclose

Malik Juweid MD, Abstract Co-Author: Nothing to Disclose

Russell Smith MD, Abstract Co-Author: Nothing to Disclose

Gerry Funk MD, Abstract Co-Author: Nothing to Disclose

Henry Hoffman MD, Abstract Co-Author: Nothing to Disclose

Michael M. Graham MD, PhD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the accuracy of post-treatment FDG-PET for detection of residual/recurrent disease in patients (pts) with squamous head and neck (H&N) cancer.

We identified all patients with squamous H&N carcinoma who were treated between 1999 and 2003 and underwent PET imaging within 3-6 months following completion of treatment and had histopathological evaluation or adequate clinical and radiological follow-up for at least 2 years. The accuracy of PET for detecting residual/recurrent or metastatic/second primary tumors was determined by comparing findings with clinical follow-up or histopathology.

A total of 100 pts, 72 oropharyngeal and 28 laryngeal cancers, met the study criteria. 48 pts were treated with surgery followed by radiation, 49 with chemoradiation only, and 3 by surgery alone. PET imaging was performed at a mean interval of 4 months post-completion of therapy. Of the 100 pts, PET was positive in 56 and negative in 44. 36/56 pts with positive PET showed histopathological evidence of disease (n=28), radiological evidence of disease progression (n=6), or were deceased upon clinical follow-up (n=2). 20/56 pts had no evidence of disease (NED) either by histopathology (n=11) or by follow-up (n=9)(median follow-up 24 months post-therapy; range, 24-34 mo.). In contrast, only 2/44 pts with a negative PET showed evidence of disease histopathologically. The remaining 42 pts continue to have NED after a median duration of 24 months (range 24-42 mo.). PET detected metastatic disease sites/second primary tumors in 21 pts (21 chest lesions, 2 abdominal lesions, 5 bone lesions). The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of PET for detection of residual/recurrent or metastatic/second primary tumors were 95% (36/38), 66% (42/62), 64% (36/56), 95% (42/44), and 78% (78/100), respectively.

Because of its high NPV, no biopsy or further diagnostic procedures are necessary if a 3-6 month post-therapy PET is negative in pts with H&N cancer. A positive PET finding, however, should be confirmed with histopathology or other imaging studies because of the limited PPV of FDG-PET.

Bartel, T, Menda, Y, Juweid, M, Smith, R, Funk, G, Hoffman, H, Graham, M, et al, , Value of FDG-PET in the Post-Therapy Surveillance of Squamous Head and Neck Cancer.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405249.html