18 F‐FDG‐PET/CT versus panendoscopy for the detection of synchronous second primary tumors in patients with head and neck squamous cell carcinoma

Background. This study assesses the additional value of 18 F‐fluoro‐2‐deoxy‐ D ‐glucose positron emission tomography/CT ( 18 F‐FDG‐PET/CT) with respect to synchronous primaries in patients undergoing panendoscopy for staging of head and neck squamous cell carcinoma. Methods. In all, 311 patients underwent both modalities. Cytology, histology, and/or clinical/imaging follow‐up served as reference standard. Results. The prevalence of second primary tumors detected by panendoscopy was 4.5%, compared with 6.1% detected by 18 F‐FDG‐PET/CT. The sensitivity for panendoscopy was 74%, the specificity was 99.7%, the positive predictive value (PPV) was 93%, and the negative predictive value (NPV) was 98%. The sensitivity for 18 F‐FDG‐PET/CT was 100%, the specificity was 95.7%, the PPV was 59%, and the NPV was 100%. Conclusions. 18 F‐FDG‐PET/CT is superior to panendoscopy. With a negative 18 F‐FDG‐PET/CT, the extent of endoscopy can be reduced to the area of the primary tumor. Due to the costs, 18 F‐FDG‐PET/CT is recommended only in advanced disease to assess potential distant disease. In early‐stage cancer, panendoscopy is accurate enough to rule out secondary tumors. © 2009 Wiley Periodicals, Inc. Head Neck, 2010