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Staging of Head and Neck Squamous Cell Cancer With Extended-Field FDG-PET
David L. Schwartz, MD;
Joseph Rajendran, MD;
Bevan Yueh, MD;
Marc Coltrera, MD;
Yoshimi Anzai, MD;
Kenneth Krohn, PhD;
Janet Eary, MD
Arch Otolaryngol Head Neck Surg. 2003;129:1173-1178.
Background Accurate baseline staging is necessary to appropriately treat head and neck squamous cell carcinoma. [F-18]-fluorodeoxyglucose positron emission tomography (FDG-PET) is valuable for locoregional staging of primary head and neck disease. The effectiveness of FDG-PET for the detection of distant metastatic or synchronous disease remains unproven.
Objective To investigate the utility of FDG-PET extended into the abdomen (extended-field FDG-PET) for wide-field staging of head and neck tumors.
Methods This is a prospective institutional study of 35 consecutive patients diagnosed with American Joint Committee on Cancer (AJCC)-defined stage II-IV squamous cell carcinoma of the oral cavity, oropharynx, or larynx between September 2000 and June 2002. Thirty-three patients (94%) were eligible for analysis. All patients were routinely staged with chest radiography, liver function tests, and extended-field FDG-PET. Chest or abdominal computed tomographic scans were used as corroborative studies and were obtained only when one of the above tests indicated distant disease.
Results Of 33 patients, 7 (21%) had evidence of distant disease by extend-field FDG-PET—4 with metastases and 3 with synchronous primary cancers of the aerodigestive tract. [F-18]-fluorodeoxyglucose PET detected hepatic, bone, gastrointestinal, and mediastinal disease not identified by chest radiography or liver function tests. Two of the 7 patients with FDG-avid distant disease had false-negative staging by all other tests, including computed tomography.
Conclusions Extended-field FDG-PET is feasible and may improve staging of primary head and neck squamous cell carcinoma. Use of staging FDG-PET must be explicitly described in reports from centers engaged in prospective research to facilitate comparison with historical results.
From the Department of Radiation Oncology (Dr Schwartz), Division of Nuclear Medicine (Drs Rajendran, Krohn, and Eary), Department of Otolaryngology–Head and Neck Surgery (Drs Yueh and Coltrera), Department of Health Service (Dr Yueh), Department of Radiology (Dr Anzai), VA Puget Sound Health Care System and University of Washington, Seattle. The authors have no relevant financial interest in this article.
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