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Effectiveness of PET/CT in the preoperative evaluation of neck disease
Author(s) -
Nguyen Anthony,
Luginbuhl Adam,
Cognetti David,
Van Abel Katie,
BarAd Voichita,
Intenzo Charles,
Keane William,
Curry Joseph
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24329
Subject(s) - medicine , mcnemar's test , radiology , magnetic resonance imaging , positron emission tomography , nuclear medicine , neck dissection , carcinoma , pathology , statistics , mathematics
Objectives/Hypothesis To evaluate the utility of positron emission tomography (PET)/computed tomography (CT) for staging the neck in the preoperative setting by comparing it to both CT/magnetic resonance imaging (MRI) and pathologic staging. Study Design Retrospective review. Methods Seventy‐one patients with initial diagnosis of head and neck squamous cell carcinoma having preoperative MR or CT imaging and PET/CT with subsequent bilateral neck dissection as part of primary treatment (142 neck dissections). Comparison of cervical nodal metastases based on three separate staging systems: preoperative CT and/or MRI scan, preoperative PET/CT, and pathology. Results Both CT/MRI scans and PET/CT scans statistically predicted pathologic outcomes ( P = 0.0001, P = 0.0001, respectively) using Chi square analysis. There was a statistically significant improvement in the prediction of true pathologic disease using PET/CT compared to CT and/or MRI alone ( P = 0.005). In a subgroup analysis including only the contralateral neck, this significance persisted ( P = 0.013). McNemar's test revealed that subsequent detection of bilateral neck disease by PET/CT scan was significantly superior to MRI or CT alone ( P = 0.023). Conclusion In pathologically positive necks, PET/CT was statistically more reliable at identifying positive disease than CT or MRI alone. Furthermore, such a result is achieved without a statistically significant difference in false positivity between PET/CT and CT or MRI. This suggests that PET/CT positivity, despite negative clinical exam and CT/MRI findings, may be more likely to signify pathologic disease and require appropriate treatment. Level of Evidence 4. Laryngoscope , 124:159–164, 2014