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Positron Emission Tomography in the Evaluation of Synchronous Lung Lesions in Patients With Untreated Head and Neck Cancer
Mark K. Wax, MD;
Larry L. Myers, MD;
Edward C. Gabalski, MD;
Syed Husain, MD;
Jayakumari M. Gona, MD;
Hani Nabi, MD
Arch Otolaryngol Head Neck Surg. 2002;128:703-707.
Background Positron emission tomography (PET) with the glucose analogue fludeoxyglucose
F 18 uses the increased glucose uptake that is observed in neoplastic cells.
It can differentiate between benign and malignant pulmonary lesions in patients
with lung tumors. Applications of PET in extracranial head and neck neoplasms
have included evaluating patients with unknown primary lesions, detecting
primary and recurrent head and neck tumors, monitoring response to radiotherapy,
and evaluating the N0 neck in oral cavity carcinomas. Its role in determining
the presence of synchronous lung lesions has not been defined.
Patients and Methods A retrospective review of 115 patients who underwent PET between October
1994 and October 1996 was performed to evaluate extracranial head and neck
neoplasms. Fifty-nine (51%) previously untreated patients with squamous cell
carcinoma of the upper aerodigestive tract were analyzed.
Results Fifteen patients (25%) had PET scans that were positive for synchronous
lung lesions. Five patients had a disease process that did not warrant further
investigation; they did not have pathological confirmation of their lung lesions.
Of these, 3 died of disease within 2 months of the diagnosis of primary head
and neck squamous cell carcinoma, 1 was unavailable for follow-up, and 1 had
lung lesions that were considered metastatic and no pathological confirmation
of lung lesions was obtained. The remaining 10 patients with positive PET
scan findings were investigated further: 8 patients had biopsy-confirmed lung
lesions; 5 patients had positive findings on chest x-ray films; 8 had positive
findings on computed tomographic scans; and 3 had positive findings on bronchoscopy.
The results of 2 PET scans were false-positive. The PET scans were important
in altering treatment in 3 patients; of these, 3 had negative findings on
chest x-ray films, 2 had positive findings on computed tomographic scans,
and 1 had positive findings on bronchoscopy.
Conclusions The overall sensitivity, positive predictive value, and accuracy of
PET were 100%, 80%, and 80%, respectively. The overall accuracy of radiography
of the chest, computed tomography of the chest, and bronchoscopy was 70%,
90%, and 50%, respectively. The accuracy of PET over bronchoscopy was statistically
significant (P<.05). PET appears to be a promising
imaging modality for the detection of synchronous lung lesions in patients
with negative findings on chest x-ray films.
From the Department of Otolaryngology–Head and Neck Surgery,
Oregon Health Sciences University, Portland (Dr Wax); the Department of Otolaryngology,
University of Michigan, Ann Arbor (Dr Myers), Long Island Surgical Specialists,
Lake Success, NY (Dr Gabalski); the Department of Nuclear Medicine, State
University of New York at Buffalo (Drs Husain, Gona, and Nabi); and the Center
for Positron Emission Tomography, Veterans Affairs Medical Center at Buffalo
(Drs Husain, Gona, and Nabi).
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