Clin Exp Otorhinolaryngol.  2008 Mar;1(1):35-40. 10.3342/ceo.2008.1.1.35.

Combined 18F-FDG PET/CT Imaging for the Initial Evaluation of Glottic Cancer

• Jeong HS
• Chung MK
• Baek CH
• Choi JY
• Son YI
• Kim HJ
• Hong SD
• Bok KH

• KMID: 1486034
• DOI: http://doi.org/10.3342/ceo.2008.1.1.35

Abstract

OBJECTIVES
The primary aim of this study was to determine whether 18F-FDG-PET/CT (PET/CT) scans provide additional diagnostic information in addition to the direct laryngoscopic examination (L/E) and contrast-enhanced CT (CT) in patients with glottic cancer during the initial evaluation. METHODS: Fifty-five consecutive patients with glottic cancer of the larynx that had L/E, CT and PET/CT were enrolled. The diagnostic value of each modality was compared for their accuracy in predicting the extent of the primary tumors on sub-site based analysis and the final tumor staging. The reference standards were either the surgical pathology findings or clinical/radiological follow-up outcome. Changes in patient care based on PET/CT results were compared with the treatment decisions based on L/E with CT. RESULTS: For primary tumor sub-site based analysis, the sensitivity was significantly higher for L/E (92.8%) than for PET/CT (79.4%, P=0.028). The comparisons between L/E vs. CT and CT vs. PET/CT did not reach statistical significance. As an initial tumor-staging method the L/E had a diagnostic accuracy of 76.4%, compared to 61.8% for CT and 41.8% for PET/CT. The L/E and CT were better than the PET/CT (P=0.0009 and 0.049) for the initial TNM staging. PET/CT scanning changed the clinical decision-making based on the L/E with CT results in 12.7% of cases, of whom 5.5% had no additional PET/CT related benefit. CONCLUSION: Conclusion. The results of this study showed that PET/CT imaging added no clinical information benefit compared to the L/E and CT for the initial evaluation of patients with glottic cancer.

Keyword

Positron emission tomography; Tomography; X-ray computed; Laryngoscopy; Laryngeal neoplasms; Glottis

MeSH Terms

Fluorodeoxyglucose F18
Follow-Up Studies
Glottis
Humans
Laryngeal Neoplasms
Laryngoscopy
Neoplasm Staging
Pathology, Surgical
Patient Care
Positron-Emission Tomography
Fluorodeoxyglucose F18

Figure

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  Fig. 1 A 62-year-old man with glottic squamous cell carcinomas in the left vocal fold. (A) Preoperative laryngoscopy shows irregular surfaced mucosal change confined to the left true vocal fold, suggesting malignant lesions, T1a. (B) The CT scans were interpreted as T1a glottic cancer, based on mucosal irregularity and abnormal contrast enhancement of the left true vocal fold. (C, D) On the PET/CT images, the left epiglottis and vallecula area showed asymmetrical increased uptake of FDG (peak standard uptake value=6.3) suggesting a malignancy, but the faint uptake in the left true vocal fold (peak standard uptake value=2.3) was considered benign. (E) The CT images of the corresponding site also revealed small enhancing lesions of the vallecula, but the radiologist interpreted the lesion as benign changes of the lingual tonsil. The initial tumor staging predicted by PET/CT standalone was supraglottic cancer cT2N0M0. The final surgical pathology demonstrated malignant cells only in the left true vocal fold without extension to supraglottis (T1a).

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