FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma

David L. Schwartz, Eric Ford, Joseph Rajendran, Bevan Yueh, Marc D. Coltrera, Jeffery Virgin, Yoshimi Anzai, David Haynor, Barbara Lewellyn, David Mattes, Juergen Meyer, Mark Phillips, Michael Leblanc, Paul Kinahan, Kenneth Krohn, Janet Eary, George E. Laramore

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

Purpose Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck. Methods and materials Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85%) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings. Results FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96% (26 of 27) and 98.5% (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (κ 0.95, 95% confidence interval 0.82-0.99) than for CT alone (κ 0.81, 95% confidence interval 0.63-0.91; p = 0.06 by two-sided McNemar's testing). Conclusion These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.

Original languageEnglish (US)
Pages (from-to)129-136
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume61
Issue number1
DOIs
StatePublished - Jan 2005

Fingerprint

Fluorodeoxyglucose F18
Positron-Emission Tomography
positrons
tomography
cancer
dissection
Neck
Neck Dissection
pathology
Carcinoma, squamous cell of head and neck
confidence
radiation therapy
Confidence Intervals
Pathology
intervals
larynx
Intensity-Modulated Radiotherapy
Hypopharynx
Oropharynx
sensitivity

Keywords

  • Cancer staging
  • Head-and-neck cancer
  • Image-guided radiotherapy
  • Multimodality imaging
  • Positron emission tomography

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma. / Schwartz, David L.; Ford, Eric; Rajendran, Joseph; Yueh, Bevan; Coltrera, Marc D.; Virgin, Jeffery; Anzai, Yoshimi; Haynor, David; Lewellyn, Barbara; Mattes, David; Meyer, Juergen; Phillips, Mark; Leblanc, Michael; Kinahan, Paul; Krohn, Kenneth; Eary, Janet; Laramore, George E.

In: International Journal of Radiation Oncology Biology Physics, Vol. 61, No. 1, 01.2005, p. 129-136.

Research output: Contribution to journalArticle

Schwartz, DL, Ford, E, Rajendran, J, Yueh, B, Coltrera, MD, Virgin, J, Anzai, Y, Haynor, D, Lewellyn, B, Mattes, D, Meyer, J, Phillips, M, Leblanc, M, Kinahan, P, Krohn, K, Eary, J & Laramore, GE 2005, 'FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma', International Journal of Radiation Oncology Biology Physics, vol. 61, no. 1, pp. 129-136. https://doi.org/10.1016/j.ijrobp.2004.03.040
Schwartz, David L. ; Ford, Eric ; Rajendran, Joseph ; Yueh, Bevan ; Coltrera, Marc D. ; Virgin, Jeffery ; Anzai, Yoshimi ; Haynor, David ; Lewellyn, Barbara ; Mattes, David ; Meyer, Juergen ; Phillips, Mark ; Leblanc, Michael ; Kinahan, Paul ; Krohn, Kenneth ; Eary, Janet ; Laramore, George E. / FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma. In: International Journal of Radiation Oncology Biology Physics. 2005 ; Vol. 61, No. 1. pp. 129-136.
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title = "FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma",
abstract = "Purpose Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck. Methods and materials Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85{\%}) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings. Results FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100{\%} and 96{\%} sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96{\%} (26 of 27) and 98.5{\%} (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (κ 0.95, 95{\%} confidence interval 0.82-0.99) than for CT alone (κ 0.81, 95{\%} confidence interval 0.63-0.91; p = 0.06 by two-sided McNemar's testing). Conclusion These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.",
keywords = "Cancer staging, Head-and-neck cancer, Image-guided radiotherapy, Multimodality imaging, Positron emission tomography",
author = "Schwartz, {David L.} and Eric Ford and Joseph Rajendran and Bevan Yueh and Coltrera, {Marc D.} and Jeffery Virgin and Yoshimi Anzai and David Haynor and Barbara Lewellyn and David Mattes and Juergen Meyer and Mark Phillips and Michael Leblanc and Paul Kinahan and Kenneth Krohn and Janet Eary and Laramore, {George E.}",
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TY - JOUR

T1 - FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma

AU - Schwartz, David L.

AU - Ford, Eric

AU - Rajendran, Joseph

AU - Yueh, Bevan

AU - Coltrera, Marc D.

AU - Virgin, Jeffery

AU - Anzai, Yoshimi

AU - Haynor, David

AU - Lewellyn, Barbara

AU - Mattes, David

AU - Meyer, Juergen

AU - Phillips, Mark

AU - Leblanc, Michael

AU - Kinahan, Paul

AU - Krohn, Kenneth

AU - Eary, Janet

AU - Laramore, George E.

PY - 2005/1

Y1 - 2005/1

N2 - Purpose Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck. Methods and materials Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85%) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings. Results FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96% (26 of 27) and 98.5% (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (κ 0.95, 95% confidence interval 0.82-0.99) than for CT alone (κ 0.81, 95% confidence interval 0.63-0.91; p = 0.06 by two-sided McNemar's testing). Conclusion These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.

AB - Purpose Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck. Methods and materials Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85%) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings. Results FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96% (26 of 27) and 98.5% (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (κ 0.95, 95% confidence interval 0.82-0.99) than for CT alone (κ 0.81, 95% confidence interval 0.63-0.91; p = 0.06 by two-sided McNemar's testing). Conclusion These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.

KW - Cancer staging

KW - Head-and-neck cancer

KW - Image-guided radiotherapy

KW - Multimodality imaging

KW - Positron emission tomography

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