Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.joms.2012.03.028
Title: The use of multiple time point dynamic positron emission tomography/computed tomography in patients with oral/head and neck cancer does not predictably identify metastatic cervical lymph nodes
Authors: Carlson, E.R.
Schaefferkoetter, J.
Townsend, D. 
McCoy, J.M.
Campbell Jr., P.D.
Long, M.
Issue Date: Jan-2013
Source: Carlson, E.R., Schaefferkoetter, J., Townsend, D., McCoy, J.M., Campbell Jr., P.D., Long, M. (2013-01). The use of multiple time point dynamic positron emission tomography/computed tomography in patients with oral/head and neck cancer does not predictably identify metastatic cervical lymph nodes. Journal of Oral and Maxillofacial Surgery 71 (1) : 162-177. ScholarBank@NUS Repository. https://doi.org/10.1016/j.joms.2012.03.028
Abstract: Purpose: To determine whether the time course of 18-fluorine fluorodeoxyglucose (18F-FDG) activity in multiple consecutively obtained 18F-FDG positron emission tomography (PET)/computed tomography (CT) scans predictably identifies metastatic cervical adenopathy in patients with oral/head and neck cancer. It is hypothesized that the activity will increase significantly over time only in those lymph nodes harboring metastatic cancer. Patients and Methods: A prospective cohort study was performed whereby patients with oral/head and neck cancer underwent consecutive imaging at 9 time points with PET/CT from 60 to 115 minutes after injection with 18F-FDG. The primary predictor variable was the status of the lymph nodes based on dynamic PET/CT imaging. Metastatic lymph nodes were defined as those that showed an increase greater than or equal to 10% over the baseline standard uptake values. The primary outcome variable was the pathologic status of the lymph node. Results: A total of 2,237 lymph nodes were evaluated histopathologically in the 83 neck dissections that were performed in 74 patients. A total of 119 lymph nodes were noted to have hypermetabolic activity on the 90-minute (static) portion of the study and were able to be assessed by time points. When we compared the PET/CT time point (dynamic) data with the histopathologic analysis of the lymph nodes, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 60.3%, 70.5%, 66.0%, 65.2%, and 65.5%, respectively. Conclusions: The use of dynamic PET/CT imaging does not permit the ablative surgeon to depend only on the results of the PET/CT study to determine which patients will benefit from neck dissection. As such, we maintain that surgeons should continue to rely on clinical judgment and maintain a low threshold for executing neck dissection in patients with oral/head and neck cancer, including those patients with N0 neck designations. © 2013 American Association of Oral and Maxillofacial Surgeons.
Source Title: Journal of Oral and Maxillofacial Surgery
URI: http://scholarbank.nus.edu.sg/handle/10635/128776
ISSN: 02782391
DOI: 10.1016/j.joms.2012.03.028
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