American Journal of Roentgenology, Vol 169, 1663-1669, Copyright © 1997 by American Roentgen Ray Society

ARTICLES

FDG PET in head and neck cancer

JW Keyes Jr, NE Watson Jr, DW Williams 3rd, KM Greven and WF McGuirt
Department of Diagnostic Radiology, Bowman Gray School of Medicine, Winston-Salem, NC 27157, USA.

In our extensive experience with FDG PET imaging in head and neck cancer, we have found the technique to be of high accuracy but of limited usefulness. This seeming paradox arises from several causes. Competing techniques such as CT, MR imaging, and even clinical examination already have good accuracy. In addition, high-resolution studies such as CT and MR imaging provide information required for treatment planning that is unavailable from FDG PET images. The high cost of FDG PET militates against its use in this setting, in which only a small marginal gain can be expected. In the special problem areas in which FDG PET might be expected to offer unique advantages, such as screening for second primary lesions, searching for unknown primary lesions, or differentiating benign salivary rumors from malignant lesions, the results of FDG PET have been disappointedly poor. Of these special problem areas, only the question of accuracy in finding occult primary lesions appears unresolved and in need of further study. The single application in which FDG PET appears to be advantageous is the posttherapy setting. In this setting, the technique is definitely superior to alternative methods of determining tumor recurrence and differentiating posttherapy sequelae such as radiation necrosis from tumor recurrence. We believe that considerable opportunity remains for further research on the use of FDG PET in head and neck cancer. Other agents such as 11C-methionine for example, might improve the diagnostic accuracy of FDG PET in some of the problem areas that we have identified, such as the early postirradiation period. We currently have such a study under way. Also, because FDG PET offers a unique way to measure tumor metabolism, further investigation of the use of FDG PET tracers to evaluate various biologic parameters such as proliferation rates or tumor hypoxia are needed. Such studies could provide a noninvasive technique to identify which fractionation schemes or combinations of therapy might be useful for individual patients. A final caveat is in order. Although our findings of the usefulness (and lack thereof) of FDG PET in head and neck cancer may be disappointing to many, these results should not be generalized to other applications of FDG PET in oncology. Each tumor type and setting presents its own specific problems, and in some instances FDG PET offers unique advantages over other imaging techniques. A good example is the setting of primary lung cancer, in which FDG PET appears clearly superior to all other methods of pretherapy screening [19-20].
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				A. M. Scott, D. H. Gunawardana, D. Bartholomeusz, J. E. Ramshaw, and P. Lin PET Changes Management and Improves Prognostic Stratification in Patients with Head and Neck Cancer: Results of a Multicenter Prospective Study J. Nucl. Med., October 1, 2008; 49(10): 1593 - 1600. [Abstract] [Full Text] [PDF]

				V. N. Shah and B. F. Branstetter IV Oncocytoma of the Parotid Gland: A Potential False-Positive Finding on 18F-FDG PET Am. J. Roentgenol., October 1, 2007; 189(4): W212 - W214. [Full Text] [PDF]

				F. R. Miller, D. Hussey, M. Beeram, T. Eng, H. S. McGuff, and R. A. Otto Positron Emission Tomography in the Management of Unknown Primary Head and Neck Carcinoma Arch Otolaryngol Head Neck Surg, July 1, 2005; 131(7): 626 - 629. [Abstract] [Full Text] [PDF]

				B. F. Branstetter IV, T. M. Blodgett, L. A. Zimmer, C. H. Snyderman, J. T. Johnson, S. Raman, and C. C. Meltzer Head and Neck Malignancy: Is PET/CT More Accurate than PET or CT Alone? Radiology, May 1, 2005; 235(2): 580 - 586. [Abstract] [Full Text] [PDF]

				V. Kapoor, M. B. Fukui, and B. M. McCook Role of 18FFDG PET/CT in the Treatment of Head and Neck Cancers: Posttherapy Evaluation and Pitfalls Am. J. Roentgenol., February 1, 2005; 184(2): 589 - 597. [Full Text] [PDF]

				S. K. Mukherji, I. M. Schmalfuss, J. Castelijns, and A. A. Mancuso Clinical Applications of Tumor Volume Measurements for Predicting Outcome in Patients with Squamous Cell Carcinoma of the Upper Aerodigestive Tract AJNR Am. J. Neuroradiol., September 1, 2004; 25(8): 1425 - 1432. [Abstract] [Full Text] [PDF]

				S. K. Mukherji and G. T. Wolf Evaluation of Head and Neck Squamous Cell Carcinoma After Treatment AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1743 - 1746. [Full Text] [PDF]

				B. Damascelli, G. L. Patelli, R. Lanocita, G. D. Tolla, L. F. Frigerio, A. Marchiano, F. Garbagnati, C. Spreafico, V. Ticha, C. R. Gladin, et al. A Novel Intraarterial Chemotherapy Using Paclitaxel in Albumin Nanoparticles to Treat Advanced Squamous Cell Carcinoma of the Tongue: Preliminary Findings Am. J. Roentgenol., July 1, 2003; 181(1): 253 - 260. [Abstract] [Full Text] [PDF]

				Y. Kitagawa, S. Nishizawa, K. Sano, T. Ogasawara, M. Nakamura, N. Sadato, M. Yoshida, and Y. Yonekura Prospective Comparison of 18F-FDG PET with Conventional Imaging Modalities (MRI, CT, and 67Ga Scintigraphy) in Assessment of Combined Intraarterial Chemotherapy and Radiotherapy for Head and Neck Carcinoma J. Nucl. Med., February 1, 2003; 44(2): 198 - 206. [Abstract] [Full Text] [PDF]

				G. W. Goerres, G. K. von Schulthess, and T. F. Hany Positron Emission Tomography and PET CT of the Head and Neck: FDG Uptake in Normal Anatomy, in Benign Lesions, and in Changes Resulting from Treatment Am. J. Roentgenol., November 1, 2002; 179(5): 1337 - 1343. [Full Text] [PDF]