Combined image interpretation of computed tomography and hybrid PET in head and neck cancer

2002 ◽  
Vol 41 (01) ◽  
pp. 14-21 ◽  
Author(s):  
J. E. Wildberger ◽  
U. Cremerius ◽  
E. DiMartino ◽  
S. Jaenicke ◽  
B. Nowak ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head And Neck Cancer ◽  
Lymph Node ◽  
Head And Neck ◽  
Neck Cancer ◽  
Image Interpretation ◽  
Lymph Node Staging ◽  
Sensitivity Specificity ◽  
Recurrent Head ◽  
Dedicated Pet

Summary Aim: Evaluation of potential synergistic effects of combined image interpretation of FDG PET using a gamma camera modified for coincidence detection (hybrid PET) and computed tomography (CT) and comparison of the diagnostic accuracy of hybrid PET and dedicated PET in patients with head and neck cancer. Methods: Forty-two patients with suspected primary or recurrent cancer were included. Twenty-four patients underwent dedicated PET in addition to attenuationcorrected hybrid PET using a one-day protocol. Results: Sensitivity, specificity and accuracy for detection of primary or recurrent head and neck cancer were 74, 73, and 74% for hybrid PET, 52, 82, and 60% for CT and 77, 82, and 79% for combined reading. With the combination of CT and hybrid PET all cases of recurrent disease were detected. The largest tumour not detected was 1.7 cm in diameter. Sensitivity, specificity and accuracy for the detection of neck sides with lymph node metastases were 69, 88, and 85% for hybrid PET, 62, 88, and 84% for CT, 69, 99, and 94% for combined image interpretation. With combined interpretation four involved neck sides were missed including two cases of microscopic metastases. Hybrid PET revealed concordant results to dedicated PET in all patients with respect to the detection of primary or recurrent tumour and in 45 of 48 neck sides (94%) with the same number of false negative findings. Conclusion: The combination of functional information of hybrid PET and morphological information of CT by the simple approach of combined image interpretation improves the sensitivity for the detection of primary/recurrent head and neck cancer and increases the specificity of lymph node staging compared to CT alone. The accuracy of hybrid PET and dedicated PET was almost identical.

FDG PET/MR for lymph node staging in head and neck cancer

2014 ◽  
Vol 83 (7) ◽  
pp. 1163-1168 ◽  
Author(s):  
Ivan Platzek ◽  
Bettina Beuthien-Baumann ◽  
Matthias Schneider ◽  
Volker Gudziol ◽  
Hagen H. Kitzler ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Node ◽  
Head And Neck ◽  
Neck Cancer ◽  
Fdg Pet ◽  
Lymph Node Staging

scholarly journals Recurrent head and neck cancer: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S181-S190 ◽  
Author(s):  
H Mehanna ◽  
A Kong ◽  
SK Ahmed
Keyword(s):  
Computed Tomography ◽  
Head And Neck Cancer ◽  
Supportive Care ◽  
Head And Neck ◽  
Neck Cancer ◽  
Transoral Surgery ◽  
Partial Laryngectomy ◽  
Management Options ◽  
Salvage Laryngectomy ◽  
Recurrent Head

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Recurrent cancers present some of the most challenging management issues in head and neck surgical and oncological practice. This is rendered even more complex by the poor evidence base to support management options, the substantial implications that treatments can have on the function and quality of life, and the difficult decision-making considerations for supportive care alone. This paper provides consensus recommendations on the management of recurrent head and neck cancer.Recommendations• Consider baseline and serial scanning with computed tomography and/or magnetic resonance (CT and/or MR) to detect recurrence in high-risk patients. (R)• Patients with head and neck cancer recurrence being considered for active curative treatment should undergo assessment by positron emission tomography combined with computed tomography (PET–CT) scan. (R)• Patients with recurrence should be assessed systematically by a team experienced in the range of management options available for recurrence including surgical salvage, re-irradiation, chemotherapy and palliative care. (R)• Management of patients with laryngeal recurrence should include input from surgeons with experience in transoral surgery and partial laryngectomy for recurrence. (G)• Expertise in transoral surgery and partial laryngectomy for recurrence should be concentrated to a few surgeons within each multidisciplinary teams. (G)• Transoral or open partial laryngectomy should be offered as definitive treatment modality for highly-selected patients with recurrent laryngeal cancer. (R)• Patients with OPC recurrence should have p16 human papilloma virus status assessed. (R)• Patients with OPC recurrence should be considered for salvage surgical treatment by an experienced team, with reconstructive expertise input. (G)• Transoral surgery appears to be an effective alternative to open surgery for the management of OPC recurrence in carefully selected patients. (R)• Consider elective selective neck dissections in patients with recurrent primaries with N0 necks, especially in advanced cases. (R)• Selective neck dissection (with preservation of nodal levels, especially level V, that are not involved by disease) in patients with nodal (N+) recurrence appears to be as effective as modified or radical neck dissections. (R)• Use salivary bypass tubes following salvage laryngectomy. (R)• Use interposition muscle-only pectoralis major or free flap for suture line reinforcement if performing primary closure following salvage laryngectomy. (R)• Use inlaid pedicled or free flap to close wound if there is tension at the anastomosis following laryngectomy. (R)• Perform secondary puncture in post chemoradiotherapy laryngectomy patients. (R)• Triple therapy with platinum, cetuximab and 5-fluorouracil (5-FU) appears to provide the best outcomes for the management of patients with recurrence who have a good performance status and are fit to receive it. If not fit, then combinations of platinum and cetuximab or platinum and 5-FU may be considered. (R)• Patients with non-resectable recurrent disease should be offered the opportunity to participate in phases I–III clinical trials of new therapeutic agents. (R)• Chemo re-irradiation appears to improve locoregional control, and may have some benefit for overall survival, at the risk of considerable acute and late toxicity. Benefit must be weighed carefully against risks, and patients must be counselled appropriately. (R)• Target volumes should be kept tight and elective nodal irradiation should be avoided. (R)• Best supportive care should be offered routinely as part of the management package of all patients with recurrent cancer even in the case of those who are being treated curatively. (R)

Lymph node staging in extracranial head and neck cancer with FDG PET – appropriate uptake period and size-dependence of the results

2002 ◽  
Vol 41 (02) ◽  
pp. 108-113 ◽  
Author(s):  
Th. Klenzner ◽  
Th. Krause ◽  
M. Mix ◽  
U. H. Ross ◽  
E. Moser ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Head And Neck ◽  
Neck Cancer ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Lymph Node Staging ◽  
Cellular Activity ◽  
Plateau Phase

Summary Aim: Identification of a rationale for the appropriate uptake period for static clinical extracranial head and neck PET imaging and evaluation of the diagnostic accuracy of such an optimized FDG PET approach for lymph node staging in the head and neck region. Methods: In a subset of 5 patients, kinetic tumour studies were performed in order to identify the cellular activity plateau phase of FDG accumulation for head and neck cancer. Seventy-eight consecutive patients (11 women, 67 men; mean age ± SD: 55 ± 11 years; range, 36-78 years), presenting with histologically proven squamous cell carcinoma and sonographically detected lymph nodes in 86 neck sides, underwent clinically indicated FDG PET imaging. PET results were compared to those derived from histological examinations and follow-up imaging results after 6 months in order to calculate sensitivity and specificity for lymph node staging. Results: FDG kinetics in head and neck cancer indicate that the cellular activity plateau of FDG accumulation is reached after an uptake period of 90 min. Using this protocol metastatic involvement of neck sides with lymph nodes less than 1 cm in diameter was correctly identified with a sensitivity of 71.4% and a specificity of 92.3%. Sensitivity increased with the lymph node diameter (1.1-1.5 cm 83.3%, 1.6-2.0 cm 100%, > 2 cm 88.9%). Conclusion: The appropriate uptake period for static clinical extracranial head and neck PET imaging that allows measurements in the activity plateau phase is about 90 min. FDG PET may add some significant information regarding metastatic spread into regional lymph nodes.

Outcomes of synchronous pulmonary nodules detected on computed tomography in head and neck cancer patients: 12-year retrospective review of a consecutive cohort

2016 ◽  
Vol 130 (6) ◽  
pp. 575-580 ◽  
Author(s):  
I Zammit-Maempel ◽  
R Kurien ◽  
V Paleri
Keyword(s):  
Computed Tomography ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Pulmonary Nodules ◽  
Newly Diagnosed ◽  
Cancer Group ◽  
Group 2 ◽  
Recurrent Head ◽  
Group 1

AbstractObjective:To investigate the long-term outcomes of pulmonary nodules detected on chest computed tomography in a consecutive cohort of patients with newly diagnosed or recurrent head and neck squamous cell cancer staged between 2001 and 2003.Results:The study included 222 patients, 148 patients with newly diagnosed head and neck cancer (group 1) and 74 patients with recurrent cancer (group 2). Abnormalities were identified in 101 patients (45.4 per cent); these were predominantly benign in group 1 (61.7 per cent) as compared to predominantly malignant in group 2 (64.3 per cent) (Fisher's exact test; p = 0.0009). Only four patients (7.4 per cent) with an initially benign-looking pulmonary nodule went on to develop malignancy over time, conferring a negative predictive value of 93 per cent for the whole cohort.Conclusion:Chest computed tomography abnormalities in patients with recurrent head and neck cancer are statistically more likely to be malignant. Very few patients with an initially benign-appearing nodule develop chest malignancy over time.

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