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FDG-PET/CT in Cancers of the Head and Neck: What is the Definition of Whole Body Scanning?

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Abstract

Purpose

The role of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) was studied in a variety of cancers, including head and neck squamous cell carcinomas (HNSCC) and nasopharyngeal carcinomas (NPC), with several presentations indicating that for these clinical entities a “whole-body” (i.e., eyes to thighs) may yield little additional information. Therefore, we were prompted to review our experience with PET/computed tomography (CT) in the management of patients with HNSCC and NPC.

Materials and Methods

This is a retrospective study of 133 patients with HNSCC, 23-90 years old (average: 58.2 ± 12.7) and 26 patients with NPC, ages 16-75 (average: 47.3 ± 17.1), who had whole body PET/CT at our institution from Jan 2003 to Nov 2006. Reinterpretation of the imaging studies for accuracy and data analysis from medical records was performed. Lesions identified on PET/CT below the level of the adrenal glands were recorded and tabulated.

Results

Lesions were identified below the adrenal glands in seven patients (5.2%) with HNSCC. These included hepatic and osseous metastases from HNSCC in two patients (1.5%), a new renal cancer (0.75%), a new pancreatic cancer (0.75%), a new colon cancer (0.75%) and findings proven benign on follow-up (focal colon uptake in one patient and an inflammatory inguinal lymph node in another patient; 1.5%). Lesions were identified below the adrenal glands in three patients (11.5%) with NPC. These included osseous metastases from NPC in two patients (7.7%) and findings proven benign on follow-up (focal colon uptake in one patient; 3.84%).

Conclusion

This study suggests that whole body PET/CT imaging in HNSCC has a relatively low yield (3%, 95% CI: 1.33-8.42) of significant findings below the level of the adrenal glands. Therefore, implementing a more limited protocol (through the level of adrenal glands), especially in low-risk cases of HNSCC, may be considered. However, whole body PET/CT imaging in NPC may have a significant yield (7.7%, 95% CI: 1.02-25.26) of medically relevant findings below the level of the adrenal glands. Thus, the whole body (i.e., vertex to thighs) PET/CT scan of NPC patients appears to be the appropriate imaging protocol for this population. This recommendation requires further evaluation and validation in larger prospective studies.

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Acknowledgment

This study was supported in part by grant NCI ICMIC P50 CA114747 (SSG).

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Authors and Affiliations

  1. Stanford Hospital and Clinics, Division of Nuclear Medicine, 300 Pasteur Dr, Room H-0101, Stanford, CA, 94305, USA

    Andrei Iagaru, Erik S. Mittra & Sanjiv Sam Gambhir

Authors
  1. Andrei Iagaru
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  2. Erik S. Mittra
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  3. Sanjiv Sam Gambhir
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Correspondence to Andrei Iagaru.

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Iagaru, A., Mittra, E.S. & Gambhir, S.S. FDG-PET/CT in Cancers of the Head and Neck: What is the Definition of Whole Body Scanning?. Mol Imaging Biol 13, 362–367 (2011). https://doi.org/10.1007/s11307-010-0343-8

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  • DOI: https://doi.org/10.1007/s11307-010-0343-8

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