Abstract
To retrospectively investigate the diagnostic accuracy of FDG-PET/CT relative to CT for detection of cervical node metastases in patients with oral squamous cell carcinoma (OSCC), using histologic evaluation of dissected cervical nodes as the reference standard. Thirty-six patients with OSCC who underwent neck dissection (4 bilateral, 32 unilateral; 250 nodal levels) after FDG-PET/CT. Two observers consensually determined the lesion size and SUVmax of visible cervical nodes and compared the results with pathologic findings at the nodal level. Histopathology revealed nodal metastases in 13 (36.1 %) of 36 patients and 28 (11.2 %) of 250 nodal levels. Using a best discriminative SUVmax cut-off of 3.5 for the node, the sensitivity, specificity and accuracy of FDG-PET/CT for identification of nodal metastases on a level-by-level basis were 67.9, 94.6, and 91.6 %, respectively. The corresponding figures for CT were 42.9, 96.8, and 90.8 %, respectively. The sensitivity of FDG-PET/CT was significantly better than CT (p = 0.023). Moreover, using the level-based modified SUVmax cut-off, the respective figures for FDG-PET/CT were 71.4, 95.9, and 93.2 %, with significantly higher sensitivity (p = 0.013) and accuracy (p = 0.041) than CT. FDG PET/CT with SUVmax is a useful modality for preoperative evaluation of cervical neck lymph node metastases in patients with OSCC.
Highlights
Pretreatment assessment of cervical lymph node metastasis is important for therapeutic planning and prognostication in patients with oral squamous cell carcinoma (OSCC) (Snow et al 1992)
Preoperative nodal status is usually evaluated by means of clinical examinations such as palpation, computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI)
Cervical lymph nodes were dissected at 250 neck levels (Ia:Ib:IIa:IIb:III:IV:V = 37:42: 40:39:40:27:25), and malignant cells were found at 28 neck levels (Ia:Ib:IIa:IIb:III:IV:V = 2:9:11:1:5:0:0)
Summary
Pretreatment assessment of cervical lymph node metastasis is important for therapeutic planning and prognostication in patients with oral squamous cell carcinoma (OSCC) (Snow et al 1992). Kitajima et al SpringerPlus (2015) 4:718 nodes is still the most reliable staging procedure It is unavoidably invasive, and a noninvasive procedure capable of providing high-quality prognostic data approaching this gold standard would be of immense value. Integrated PET/CT has been applied successfully for evaluation of squamous cell carcinoma of the head and neck (HNSCC), and recent reports have suggested that it is useful for evaluation of nodal involvement in OSCC. There is growing evidence that FDG-PET or PET/CT is a more reliable and accurate imaging tool than CT for evaluation of cervical neck lymph node metastasis in OSCC (Matsubara et al 2012; Ng et al 2005; Yamazaki et al 2008). Several reports have indicated that FDG-PET or PET/CT offers no advantage, especially for evaluation of the N0 neck in early OSCC (Krabbe et al 2008; Nahmias et al 2007; Schöder et al 2006), and its diagnostic value remains controversial
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