Positron emission tomography in the evaluation of the negative neck in patients with oral cavity cancer

Objective: Proper management of the clinically negative neck (NO) in patien ts with squamous cell carcinoma (SCC) of the oral cavity (OC) is controvers ial. Detecting cervical metastasis in these patients is important, because cervical lymph node metastasis is associated with an unfavourable prognosis . Conventional radiographic studies, such as computerized tomography (CT) a nd magnetic resonance imaging (MRI), may augment physical examination. Howe ver, there are still limitations of these modalities in detecting the prese nce of metastatic cervical disease. Positron emission tomography (PET) is a functional imaging modality that has recently been used in patients to det ect head and neck neoplasms. We report using PET in the evaluation of the N O neck in 11 consecutive patients with SCC of the OC who underwent neck dis section. Method: The results of PET scans were correlated with the pathologic findin gs of 19 neck dissections. Results: Four patients (36%) undergoing 7 neck dissections (37%) had pathol ogic evidence of disease. Positron emission tomography scans were positive in all of these patients and in all pathologically confirmed cervical metas tasis. Seven patients (64%) undergoing 12 neck dissections (63%) had no pat hologic evidence of cervical metastasis. Positron emission tomography scans were negative for malignancy in all of these seven patients. In the patien t with SCC of the OC with a clinically NO neck, we found PET to have an ove rall sensitivity, specificity, positive predictive value, negative predicti ve value, and accuracy of 100%. Computerized tomography demonstrated 40%, 8 8%, 67%, 70%, 69%, respectively. In all statistical categories except speci ficity (p = .1), PET demonstrated statistical significance (p < .05) over C T. Conclusion: Positron emission tomography appears to be a promising diagnost ic aid that may be applied when evaluating the NO neck for patients with SC C of the OC.