18F-FDG PET for detecting metastases and synchronous primary malignancies in patients with oral and oropharyngeal cancer

P. Wallowy; J. Diener; F. Grünwald; A. F. Kovács

doi:10.3413/nukmed-0242

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2009; 48(05): 192-199
DOI: 10.3413/nukmed-0242

Original article

Schattauer GmbH

¹⁸F-FDG PET for detecting metastases and synchronous primary malignancies in patients with oral and oropharyngeal cancer

¹⁸F-FDG PET zum Nachweis von Fernmetastasen und Zweitmalignomen bei Patienten mit einem Plattenepithelkarzinom der Mundhöhle und des Oropharynx

Authors

P. Wallowy

¹Department of Oral and Cranio-Maxillofacial Plastic Surgery, Goethe University Medical Centre, Frankfurt am Main, Germany
J. Diener

²Department of Nuclear Medicine, Goethe University Medical Centre, Frankfurt am Main, Germany
F. Grünwald

²Department of Nuclear Medicine, Goethe University Medical Centre, Frankfurt am Main, Germany
A. F. Kovács

¹Department of Oral and Cranio-Maxillofacial Plastic Surgery, Goethe University Medical Centre, Frankfurt am Main, Germany

Abstract

Summary

Aim: Assessment of the efficiency of ¹⁸F-FDGPET (PET) for the detection of distant metastases and synchronous primary malignancies in patients with oral and oropharyngeal squamous cell cancer (OOSCC). Patients, methods: Retrospective evaluation of PET studies of 422 patients with histologically confirmed OOSCC. 99 patients (23.5%) demonstrated a suspect distant finding of whom 84 could be interdisciplinary evaluated and consecutively confirmed or refuted by other diagnostic modalities or biopsy. Results: In 74 of 80 evaluable cases, PET showed the primary tumour (92.5%). 26/84 suspect distant lesions (31%) showed by means of PET were confirmed to be malignancies (mean SUV 3.96; range 1.4-9.37). Main sites were the lung, the upper aerodigestive tract, and the gastrointestinal system. In the other 58 cases (69%), where the suspect lesions were confirmed as benign, mean SUV was 2.65 (range 0.7–6.5) (difference statistically significant). The SUV above which every suspect finding was proven to be of malignant condition was 6.5 (specificity 100%, sensitivity 38%, accuracy 81%). Conclusion: PET may have an important role in initial staging and the detection of distant metastases and synchronous primary malignancies. Setting a SUV threshold for determining malignancies can support interpretation. In borderline cases, however, interdisciplinary evaluation by means of other diagnostic modalities remains crucial.

Zusammenfassung

Ziel: Untersuchung der Effektivität der ¹⁸F-FDGPET (PET) zum Nachweis von Fernmetastasen und Zweitmalignomen bei Patienten mit einem Plattenepithelkarzinom der Mundhöhle und des Oropharynx. Patienten, Methoden: Retrospektive Beurteilung von PET-Untersuchungen bei 422 Patienten mit einem histologisch bestätigten Plattenepithelkarzinom der Mundhöhle und des Oropharynx. 99 Patienten (23,5%) zeigten verdächtige Befunde außerhalb des Primarius, von denen 84 interdisziplinär untersucht und durch weiterführende Diagnostik oder Biopsien verifiziert oder widerlegt werden konnten. Ergebnisse: Bei 74 von 80 auswertbaren Patienten bestätigte die PET die Primärtumore (92,5%). Bei 26/84 (31%) der in der PET verdächtigen Befunde außerhalb des Primarius konnten Malignome bestätigt werden (SUV durchschnittlich 3,96; Bereich 1,4–9,37). Hauptlokalisationen waren Lunge, oberer Aerodigestivtrakt und gastrointestinales System. 58/84 der verdächtigen Befunde stellten sich als gutartige Geschehen dar (69%) mit einem SUV-Durchschnitt von 2,65 (Bereich 0,7–6,5) (Unterschied statistisch signifikant). Der SUV, oberhalb dessen der Nachweis eines verdächtigen Befundes immer positiv auf Malignität war, war 6,5 (Spezifität 100%, Sensitivität 38%, Genauigkeit 81%). Schlussfolgerung: Die PET kann eine wichtige Funktion bei dem initialen Staging und bei der Detektion von Fernmetastasen und Zweitmalignomen übernehmen. Das Aufstellen einer SUV-Grenze zur Bestimmung von Malignitäten kann die Interpretation unterstützen. In Grenzfällen jedoch bleibt die Bestätigung durch weiterführende Diagnostik entscheidend.

Keywords

¹⁸F-FDG PET - oral and oropharyngeal squamous cell cancer - distant metastases - synchronous primary malignancies - standard uptake value

Schlüsselwörter

¹⁸F-FDG-PET - Plattenepithelkarzinome der Mundhöhle und des Oropharynx - Fernmetastasen - Zweitmalignome - SUV

Volltext

Referenzen

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