Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2009

01-11-2009 | Head and Neck Oncology

Metabolic Tumor Volumes by [18F]-Fluorodeoxyglucose PET/CT Correlate with Occult Metastasis in Oral Squamous Cell Carcinoma of the Tongue

Authors: Man Ki Chung, MD, Han-Sin Jeong, MD, PhD, Young-Ik Son, MD, PhD, Yoon Kyoung So, MD, Ga Young Park, MD, Joon Young Choi, MD, PhD, Seung Hyup Hyun, MD, Hyung-Jin Kim, MD, PhD, Young-Hyeh Ko, MD, PhD, Chung-Hwan Baek, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2009

Login to get access

Abstract

Background

To investigate the correlation between pretreatment metabolic tumor volume (MTV) as determined by [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and occult metastasis (OM) in oral squamous cell carcinoma (OSCC) of the tongue.

Methods

Forty-three clinically node-negative (cN0) OSCC patients, diagnosed by preoperative workups (biopsy, physical examination, CT, and PET/CT) were enrolled. All patients had undergone primary tumor resections and elective neck dissections. MTVs were measured for tumors showing standardized uptake value (SUV) of >2.5 by an automated contouring program. Pretreatment variables (age, sex, clinical T stage, maximal SUV [SUVmax] and MTV) and posttreatment variables (pathologic T stage, depth of invasion, lymphovascular invasion, pathologic tumor volume, and histological differentiation) were analyzed to identify their correlation with OM.

Results

Twelve (27.9%) of 43 patients were found to have OM in pathologic specimen of neck dissections. A cutoff of 6.0 ml for the MTV was determined to be the most discriminative value for predicting OM. By univariate analysis, the patients with an MTV of >6.0 ml had significantly higher number of occult metastases than those with an MTV of ≤6.0 ml (57.1% vs. 13.7%, hazard ratio 8.33, 95% confidence interval, 1.95–35.6, P = 0.009). Lymphovascular invasion and SUVmax showed only trends toward significance (P = 0.08 and 0.05, respectively). By multivariate analysis, only MTV had a significant correlation with OM (hazard ratio 54.66, 95% confidence interval, 1.05–2842.86, P = 0.04).

Conclusions

MTV as determined by PET/CT demonstrated a statistically significant correlation with OM in patients with cN0 OSCC of the tongue.
Literature
1.
Fakih AR, Rao RS, Borges AM, Patel AR. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg. 1989;158:309–13.CrossRefPubMed
2.
Friedman M, Mafee MF, Pacella BL Jr, et al. Rationale for elective neck dissection in 1990. Laryngoscope. 1990;100:54–9.PubMed
3.
Vandenbrouck C, Sancho-Garnier H, Chassagne D, et al. Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial. Cancer. 1980;46:386–90.CrossRefPubMed
4.
Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg. 1994;120:699–702.PubMed
5.
Yuen AP, Wei WI, Wong YM, Tang KC. Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck. 1997;19:583–8.CrossRefPubMed
6.
Martinez-Gimeno C, Rodriguez EM, Vila CN, Varela CL. Squamous cell carcinoma of the oral cavity: a clinicopathologic scoring system for evaluating risk of cervical lymph node metastasis. Laryngoscope. 1995;105:728–33.CrossRefPubMed
7.
Mohit-Tabatabai MA, Sobel HJ, Rush BF, Mashberg A. Relation of thickness of floor of mouth stage I and II cancers to regional metastasis. Am J Surg. 1986;152:351–3.CrossRefPubMed
8.
Moore C, Kuhns JG, Greenberg RA. Thickness as prognostic aid in upper aerodigestive tract cancer. Arch Surg. 1986;121:1410–4.PubMed
9.
Morton RP, Ferguson CM, Lambie NK, Whitlock RM. Tumor thickness in early tongue cancer. Arch Otolaryngol Head Neck Surg. 1994;120:717–20.PubMed
10.
O-charoenrat P, Pillai G, Patel S, Fisher C, Archer D, Eccles S et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol. 2003;39:386–90.CrossRefPubMed
11.
Po Wing Yuen A, Lam KY, Lam LK, et al. Prognostic factors of clinically stage I and II oral tongue carcinoma—a comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck. 2002;24:513–20.CrossRefPubMed
12.
Rasgon BM, Cruz RM, Hilsinger RL Jr, Sawicki JE. Relation of lymph-node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: a case series and literature review. Laryngoscope. 1989;99:1103–10.CrossRefPubMed
13.
Shingaki S, Suzuki I, Nakajima T, Kawasaki T. Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas. Oral Surg Oral Med Oral Pathol. 1988;66:683–8.CrossRefPubMed
14.
Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg. 1986;152:345–50.CrossRefPubMed
15.
Woolgar JA, Scott J. Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth. Head Neck. 1995;17:463–72.CrossRefPubMed
16.
Yuen PW, Lam KY, Chan AC, Wei WI, Lam LK. Clinicopathological analysis of local spread of carcinoma of the tongue. Am J Surg. 1998;175:242–4.CrossRefPubMed
17.
Brouwer J, de Bree R, Comans EF, Castelijns JA, Hoekstra OS, Leemans CR. Positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior? Eur Arch Otorhinolaryngol. 2004;261:479–83.CrossRefPubMed
18.
Hyde NC, Prvulovich E, Newman L, Waddington WA, Visvikis D, Ell P. A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography. Oral Oncol. 2003;39:350–60.CrossRefPubMed
19.
Stoeckli SJ, Steinert H, Pfaltz M, Schmid S. Is there a role for positron emission tomography with 18F-fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma. Head Neck. 2002;24:345–9.CrossRefPubMed
20.
Benchaou M, Lehmann W, Slosman DO, Becker M, Lemoine R, Rufenacht D, et al. The role of FDG-PET in the preoperative assessment of N-staging in head and neck cancer. Acta Otolaryngol. 1996;116:332–5.CrossRefPubMed
21.
Hlawitschka M, Neise E, Bredow J, Beuthien-Baumann B, Haroske G, Eckelt U, et al. FDG-PET in the pretherapeutic evaluation of primary squamous cell carcinoma of the oral cavity and the involvement of cervical lymph nodes. Mol Imaging Biol. 2002;4:91–8.CrossRefPubMed
22.
Ng SH, Yen TC, Chang JT, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol. 2006;24:4371–6.CrossRefPubMed
23.
Ng SH, Yen TC, Liao CT, et al. 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med. 2005;46:1136–43.PubMed
24.
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;32:1548–55.PubMed
25.
Minn H, Clavo AC, Grenman R, Wahl RL. In vitro comparison of cell proliferation kinetics and uptake of tritiated fluorodeoxyglucose and l-methionine in squamous-cell carcinoma of the head and neck. J Nucl Med. 1995;36:252–8.PubMed
26.
Minn H, Joensuu H, Ahonen A, Klemi P. Fluorodeoxyglucose imaging: a method to assess the proliferative activity of human cancer in vivo. Comparison with DNA flow cytometry in head and neck tumors. Cancer. 1988;61:1776–81.CrossRefPubMed
27.
Cerfolio RJ, Bryant AS, Ohja B, Bartolucci AA. The maximum standardized uptake values on positron emission tomography of a non-small cell lung cancer predict stage, recurrence, and survival. J Thorac Cardiovasc Surg. 2005;130:151–9.CrossRefPubMed
28.
Davies A, Tan C, Paschalides C, Barrington SF, O'Doherty M, Utley M, et al. FDG-PET maximum standardised uptake value is associated with variation in survival: analysis of 498 lung cancer patients. Lung Cancer. 2007;55:75–8.CrossRefPubMed
29.
Sasaki R, Komaki R, Macapinlac H, et al. [18F]fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non-small-cell lung cancer. J Clin Oncol. 2005;23:1136–43.CrossRefPubMed
30.
Lee P, Weerasuriya DK, Lavori PW, et al. Metabolic tumor burden predicts for disease progression and death in lung cancer. Int J Radiat Oncol Biol Phys. 2007;69:328–33.PubMed
31.
Greene FL. The American Joint Committee on Cancer: updating the strategies in cancer staging. Bull Am Coll Surg. 2002;87:13–5.PubMed
32.
Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol. 1992;158:961–9.PubMed
33.
Greco C, Rosenzweig K, Cascini GL, Tamburrini O. Current status of PET/CT for tumour volume definition in radiotherapy treatment planning for non–small cell lung cancer (NSCLC). Lung Cancer. 2007;57:125–34.CrossRefPubMed
34.
Miller TR, Grigsby PW. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated by radiation therapy. Int J Radiat Oncol Biol Phys. 2002;53:353–9.PubMed
35.
36.
Yii NW, Patel SG, Rhys-Evans PH, Breach NM. Management of the N0 neck in early cancer of the oral tongue. Clin Otolaryngol Allied Sci. 1999;24:75–9.CrossRefPubMed
37.
Bradley J, Thorstad WL, Mutic S, et al. Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2004;59:78–86.PubMed
38.
Bradley JD, Ieumwananonthachai N, Purdy JA, Wasserman TH, Lockett MA, Graham MV, et al. Gross tumor volume, critical prognostic factor in patients treated with three-dimensional conformal radiation therapy for non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys. 2002;52:49–57.CrossRefPubMed
39.
Gilbert RW, Birt D, Shulman H, Freeman J, Jenkin D, MacKenzie R, et al. Correlation of tumor volume with local control in laryngeal carcinoma treated by radiotherapy. Ann Otol Rhinol Laryngol. 1987;96:514–8.PubMed
40.
Zasadny KR, Kison PV, Francis IR, Wahl RL. FDG-PET determination of metabolically active tumor volume and comparison with CT. Clin Positron Imaging. 1998;1:123–9.CrossRefPubMed
41.
van der Brekel MW, van der Waal I, Meijer CJ, Freeman JL, Castelijns JA, Snow GB. The incidence of micrometatstases in neck dissection specimens obtained from elective neck dissections. Laryngoscope. 1996;106:987–91.CrossRefPubMed
42.
Stoeckli SJ. Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck. Laryngoscope. 2007;117:1539–51.CrossRefPubMed
43.
Cantwell CP, Setty BN, Holalkere N, Sahani DV, Fischman AJ, Blake MA. Liver lesion detection and characterization in patients with colorectal cancer: a comparison of low radiation dose non-enhanced PET/CT, contrast-enhanced PET/CT, and liver MRI. J Comput Assist Tomogr. 2008;32:738–44.CrossRefPubMed
44.
Strobel K, Heinrich S, Bhure U, Soyka J, Veit-Haibach P, Pestalozzi BC, et al. Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med. 2008;49:1408–13.CrossRefPubMed
Metadata
Title
Metabolic Tumor Volumes by [18F]-Fluorodeoxyglucose PET/CT Correlate with Occult Metastasis in Oral Squamous Cell Carcinoma of the Tongue
Authors
Man Ki Chung, MD
Han-Sin Jeong, MD, PhD
Young-Ik Son, MD, PhD
Yoon Kyoung So, MD
Ga Young Park, MD
Joon Young Choi, MD, PhD
Seung Hyup Hyun, MD
Hyung-Jin Kim, MD, PhD
Young-Hyeh Ko, MD, PhD
Chung-Hwan Baek, MD, PhD
Publication date
01-11-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0621-3

Other articles of this Issue 11/2009

Annals of Surgical Oncology 11/2009 Go to the issue

Endocrine Tumors

Defining Surgical Indications for Type I Gastric Carcinoid Tumor

Colorectal Cancer

Lymph Node Evaluation of Colon Cancer and Its Association with Improved Staging and Survival in the Department of Defense Health Care System

Melanomas

Nonsentinel Node Metastases in Melanoma: Do They Reflect the Biology of the Tumor, the Lymph Node or the Surgeon?

Bone and Soft Tissue Sarcomas

Prognostic Effect of Diaphyseal Location in Osteosarcoma: A Cohort Case–Control Study at a Single Institute

Melanomas

Evaluation of Lymphatic Drainage Patterns to the Groin and Implications for the Extent of Groin Dissection in Melanoma Patients

Endocrine Cancer

Merkel Cell Carcinoma: Our Therapeutic Algorithm