Clin Exp Otorhinolaryngol.  2008 Jun;1(2):103-109. 10.3342/ceo.2008.1.2.103.

Use of 18F-Fluorodeoxyglucose Positron Emission Tomography in Patients with Rare Head and Neck Cancers

• Roh JL
• Moon BJ
• Kim JS
• Lee JH
• Cho KJ
• Choi SH
• Nam SY
• Lee BJ
• Kim SY

• KMID: 1486062
• DOI: http://doi.org/10.3342/ceo.2008.1.2.103

Abstract

OBJECTIVES
The clinical utility of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been demonstrated in major head and neck cancers (HNCs) but is unclear in rare HNCs. We therefore evaluated FDG PET in the management of patients with rare HNCs. METHODS: FDG PET and CT/MRI scanning were performed at the initial staging and/or the follow-up in 24 patients with rare HNCs, 10 with melanoma, 9 with sarcoma, 3 with olfactory neuroblastomas, and 2 with basal cell carcinoma. The diagnostic accuracy of CT and FDG PET for detecting primary tumors and metastases were compared with a histopathologic reference. The association between the PET results and the clinicopathologic parameters predicting tumor invasion, histologic grade and disease-free survival (DFS), was assessed. RESULTS: The overall accuracies of FDG PET and CT/MRI were 92% and 79%, respectively, for detecting primary tumors and 91% and 74%, respectively, for nodal metastases, but the differences were not significant due to the small number of patients. The sensitivity and specificity of FDG PET for detecting distant metastases and second primary tumors were 100% and 87%, respectively. Follow-up FDG PET correctly diagnosed locoregional recurrence in all 12 patients, as shown by biopsy, and distant metastases in 6 patients. However, thickness of melanoma, histologic grade of sarcoma, and DFS were not associated with tumor FDG uptake. CONCLUSION: FDG PET may be useful for staging, posttreatment monitoring, and detection of distant metastases and second primary tumors in patients with rare HNCs.

Keyword

Head and neck neoplasms; Fluorodeoxyglucose; Positron-emission tomography; Neoplasm staging; Surveillance

MeSH Terms

Biopsy
Carcinoma, Basal Cell
Disease-Free Survival
Electrons
Esthesioneuroblastoma, Olfactory
Follow-Up Studies
Head
Head and Neck Neoplasms
Humans
Melanoma
Neck
Neoplasm Metastasis
Neoplasm Staging
Positron-Emission Tomography
Recurrence
Sarcoma
Sensitivity and Specificity

Figure

• 

  Fig. 1 Detection of primary tumor and nodal metastasis by FDG PET. (A-C) Whole body FDG PET showing focal FDG uptake in the left anterior nasal cavity (arrowheads) and upper neck (arrows) of a 40-yr-old melanoma patient (case no. 5). (D, E) Axial CT scans showing the ab-sence of significant lesions in the nasal cavity and upper neck. Both lesions were confirmed by surgical pathology.

• 

  Fig. 2 False results of both FDG PET and MRI. (A, B) Whole body FDG PET showing focal FDG uptake in the left posterior neck (black arrows) and no other sites of a 22-yr-old sarcoma patient (case no. 19). (C) Gadolinium-enhanced axial T1-weighted MR image showing a strongly enhancing lymph node (white arrow). Surgical pathology revealed a 1-cm-sized, round cell sarcoma in the skin and superficial subcutaneous tissue on the left scalp but no cervical nodal metastases. The positive node on PET and MRI was a reactive lymph node.

• 

  Fig. 3 Detection of regional recurrence and distant metastasis by FDG PET. (A-C) Whole body FDG PET showing focal FDG uptakes in the left neck (arrows) and L1 vertebra (arrowheads) of a 64-yr-old melanoma patient (case no. 9). (D) Axial CT scan showing a bony metastatic lesion in the left side of the L1 vertebral body.

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