Role of 18F-FDG PET/CT in Management of High-Grade Salivary Gland Malignancies

Abstract

The role of 18F-FDG PET/CT for planning the treatment of high-grade salivary gland malignancies was investigated and was compared with that with using contrast-enhanced CT. The subjects chosen for the study had high-grade cancer of the salivary gland, as confirmed by surgical pathology. The diagnostic values from 37 CT and PET/CT scans of 33 subjects were compared. The ability to predict the extent of the disease was compared by performing a subsite-based analysis for the primary lesions and a level-by-level analysis for the neck node levels as well as for the final TNM staging. The surgical pathology (67.6%) and clinical follow-up examinations (32.4%) were used as the reference standards. Furthermore, the changes made in each subject's care, based on a PET/CT examination, were compared with the treatment received without using the PET/CT data. Using a primary subsite-based analysis, the diagnostic accuracy for predicting the pathologic tumor extent was significantly higher for PET/CT (91.0%) compared with that using CT alone (70.1%, P < 0.001). For the neck nodes on a level-by-level analysis, the metastasis could be predicted more accurately on the basis of a PET/CT examination (97.6%) than with using only CT (86.0%, P = 0.01). PET/CT was also far superior to CT in terms of the TNM staging (83.7% vs. 62.1%, P = 0.03). For 43.2% of the subjects, changes in the clinical decision making were made as a result of the PET/CT scan data over what was previously determined by using the CT scans alone. PET/CT provides more accurate diagnostic information for the evaluation of high-grade salivary cancer than does CT and it has a major impact on making treatment decisions for patients with a high-grade salivary malignancy.