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Indian Journal of Otolaryngology and Head & Neck Surgery

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08-04-2023 | Neck Disease | Original Article

Role of ¹⁸F-FDG PET/CT in Guiding Surgical Management of Clinically Node Negative Neck (cN0) in Carcinoma Oral Cavity

Authors: Anushree Vartak, Munish Malhotra, Pradeep Jaiswal, Rajnish Talwar, Arvind Tyagi, Brij Kishore

Published in: Indian Journal of Otolaryngology and Head & Neck Surgery | Issue 3/2023

Abstract

Conventional staging paradigm with clinical examination or imaging invariably leads to underestimation of occult metastatic neck disease in oral cavity carcinoma. The advantage of ¹⁸F-FDG PET/CT is in its ability to identify lymph nodes without morphological changes yet harboring occult metastases. We present findings of our study to evaluate diagnostic accuracy of ¹⁸F-FDG PET/CT, in detecting occult cervical lymph node metastasis in carcinoma oral cavity. In a single institution prospective study, 51 consecutive patients with histologically proven (cT1/T2) oral cavity carcinoma and clinically node negative neck (cNo), underwent ¹⁸F-FDG PET/CT before elective neck dissection of 58 neck sides. ¹⁸F-FDG PET/CT findings were compared with histopathology of dissected nodes, to calculate diagnostic accuracy. ¹⁸F-FDG PET/CT correctly characterized the occult lymph node metastasis status (true positive + true negative) in 51 of 58 neck sides, yielding diagnostic accuracy of 87.93%. Sensitivity of ¹⁸F-FDG PET/CT was 90% and specificity was 87.5%. While a positive ¹⁸F-FDG PET/CT accurately predicted the disease in only 60% (positive predictive value), a negative ¹⁸F-FDG PET/CT reasonably ruled out occult metastases in 97.67% (negative predictive value). If a decision regarding the need for neck dissection had been based solely on ¹⁸F-FDG PET/CT, the number of neck dissections would have been reduced by 74.13%. Based on diagnostic accuracy and high negative predictive value, incorporating ¹⁸F-FDG PET/CT in preoperative staging paradigm of cT1/T2 carcinoma oral cavity will guide in selection of patients in which cN0 neck can be safely observed.

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Title: Role of 18F-FDG PET/CT in Guiding Surgical Management of Clinically Node Negative Neck (cN0) in Carcinoma Oral Cavity
Authors: Anushree Vartak
Munish Malhotra
Pradeep Jaiswal
Rajnish Talwar
Arvind Tyagi
Brij Kishore
Publication date: 08-04-2023
Publisher: Springer India
Keywords: Neck Disease
Computed Tomography
Metastasis
Computed Tomography
Neck Dissection
Published in: Indian Journal of Otolaryngology and Head & Neck Surgery / Issue 3/2023
Print ISSN: 2231-3796
Electronic ISSN: 0973-7707
DOI: https://doi.org/10.1007/s12070-023-03744-y

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Springer Medicine

Role of ¹⁸F-FDG PET/CT in Guiding Surgical Management of Clinically Node Negative Neck (cN0) in Carcinoma Oral Cavity

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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