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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Head and Neck Oncology

Preoperative Contrast-Enhanced CT Versus 18F-FDG PET/CT Evaluation and the Prognostic Value of Extranodal Extension for Surgical Patients with Head and Neck Squamous Cell Carcinoma

Authors: Jae Ryung Lee, MD, Young Jun Choi, MD, Jong-Lyel Roh, MD, Jae Seung Kim, MD, Jeong Hyun Lee, MD, Kyung-Ja Cho, MD, Seung-Ho Choi, MD, Soon Yuhl Nam, MD, Sang Yoon Kim, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Background

Extranodal extension (ENE) is a poor prognostic indicator for patients with head and neck squamous cell carcinoma (HNSCC), but pretreatment detection assists with proper treatment planning. This study evaluated whether the ENE of HNSCC is accurately detected by computed tomography (CT) versus fluorine 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and whether it has any impact on patient prognosis.

Methods

In this study, 186 HNSCC patients were preoperatively evaluated using contrast-enhanced CT and 18F-FDG PET/CT. The histopathologic findings for the neck dissection samples served as a standard reference. McNemar’s test and logistic regression using the generalized estimating equations were used to compare the diagnostic value of CT versus 18F-FDG PET/CT, and Cox proportional hazard regression was used to assess the prognostic value of ENE.

Results

Among the 186 study patients, 113 (60.8 %) had a neck metastasis, 44 (23.7 %) had pathologic ENE, and 37 (19.9 %) had macroscopic ENE. Radiologic ENE (rENE) on CT was documented for 48 patients (25.8 %) and 52 neck sides (19.8 %). Using 4.9 as the cutoff value for nodal maximum standardized uptake, 18F-FDG PET/CT documented rENE for 44 patients (23.7 %) and 48 neck sides (18.3 %). Compared with 18F-FDG PET/CT, CT detected ENE, with a specificity of 92.1 versus 74.4 % (p < 0.001) and an accuracy of 88.6 versus 75.3 % (p < 0.001). However, rENE was not a significant predictor of recurrence or survival (p > 0.05).

Conclusion

The findings showed that ENE of HNSCC is more accurately detected by using CT than by using 18F-FDG PET/CT. The accurate pretreatment detection of ENE may help in the planning for HNSCC treatments.
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Metadata
Title
Preoperative Contrast-Enhanced CT Versus 18F-FDG PET/CT Evaluation and the Prognostic Value of Extranodal Extension for Surgical Patients with Head and Neck Squamous Cell Carcinoma
Authors
Jae Ryung Lee, MD
Young Jun Choi, MD
Jong-Lyel Roh, MD
Jae Seung Kim, MD
Jeong Hyun Lee, MD
Kyung-Ja Cho, MD
Seung-Ho Choi, MD
Soon Yuhl Nam, MD
Sang Yoon Kim, MD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4689-7

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