Author(s): Ryan WR, Fee WE Jr, Le QT, Pinto HA
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Abstract OBJECTIVES/HYPOTHESIS: To determine the diagnostic accuracy and the ideal timing of fluoro-fluorodeoxyglucose positron-emission tomography (PET) in the posttreatment surveillance of head and neck mucosal squamous cell carcinoma (HNSCC). STUDY DESIGN: Retrospective chart review. METHODS: Our sample includes 103 adult patients with 118 posttreatment PET scans who had undergone treatment for HNSCC. We correlated PET results with surgical pathology and clinical outcome in the subsequent 6 months. RESULTS: For the detection of locoregional persistent or recurrent HNSCC, PET scans had a sensitivity of 82\%, specificity of 92\%, positive predictive value (PPV) of 64\%, negative predictive value (NPV) of 97\%, and overall accuracy of 90\%. For the detection of distant metastases, PET scans had a sensitivity of 89\%, specificity of 97\%, PPV of 85\%, NPV of 98\%, and overall accuracy of 96\%. PET scans of the head and neck region performed greater than 1 month after the completion of radiation compared with scans performed within 1 month had a significantly higher sensitivity of 95\% versus 55\% (P < .01) and NPV of 99\% versus 90\% (P < .01). CONCLUSION: PET is effective in detecting distant metastases in the posttreatment surveillance for HNSCC patients. A negative PET is highly reliable for all sites. However, a positive PET in the head and neck region is unreliable because of a high false-positivity rate. PET of the head and neck region has a statistically significant risk of a false-negative reading when performed within 1 month of radiation.
This article was published in Laryngoscope
and referenced in Otolaryngology: Open Access