Utility of 18F-FDG PET-CT in staging and restaging of patients with malignant salivary gland tumours

Abstract

The aim of this study was to evaluate the clinical utility of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) in staging and restaging of patients with malignant primary salivary gland tumours. Data pertaining to 30 patients (age: 43.8±16.8 years; male/female: 20/10) with histopathologically proven malignant primary salivary gland tumours who underwent 36 F-FDG PET-CTs were retrospectively analysed. Ten PET-CTs were performed for staging and 26 for restaging. The primary site was the parotid gland in 22 patients, the submandibular gland in seven and the minor salivary gland in one patient. (18)F-FDG PET-CT images were revaluated by two nuclear medicine physicians in consensus. Findings were grouped into local disease, nodal disease and distant metastasis. Results were compared with those of conventional imaging modalities [CIM (CT/ultrasound/bone scintigraphy)] when available (n=28). Clinical or imaging follow-up (minimum 6 months) data along with histopathological information (when available) were taken as the reference standard. Overall, 25 PET-CTs were positive and 11 were negative for disease. (18)F-FDG PET-CT showed local disease in 21 patients, nodal disease in 17 and distant metastasis in nine (lungs, four; liver, three; bones, four; and thyroid, one). Twenty-three PET-CTs were true positive, nine were true negative, two were false positive and two were false negative. The overall sensitivity of (18)F-FDG PET-CT was 92%, specificity was 82%, positive predictive value was 92%, negative predictive value was 82% and accuracy was 89%. No significant difference was seen in the accuracy of PET-CT between the staging and restaging groups (100 vs. 85%; P=0.468). In patients for whom comparable CIM data were available (n=28), PET-CT did not show any significant advantage over CIM (P=0.012) but was more specific (71 vs. 43%). (18)F-FDG PET-CT shows high accuracy in staging and restaging of patients with malignant primary salivary gland tumours. It is more specific than CIM for this purpose.