Lymph node detection of head and neck squamous cell carcinomas by positronemission tomography with fluorodeoxyglucose F 18 in a routine clinical setting

Background: Accurate determination of lymph node involvement is a prerequis ite for individualized therapy in patients with squamous cell carcinoma of the head and neck region. In a previous study, we showed that positron emis sion tomography (PET) with fluorodeoxyglucose F 18 with and without attenua tion correction is superior to magnetic resonance imaging for this purpose in a scientific setting. Objective: To evaluate the diagnostic accuracy of a shortened PET protocol (acquisition time, 20 minutes) in a routine clinical setting. Design: The results of static, nonattenuation-corrected PET performed on pa tients in 2 bed positions starting 40 minutes after the intravenous injecti on of 370 MBq of fluorodeoxyglucose F 18 and the results of morphologic pro cedures (computed tomography and magnetic resonance imaging) were compared prospectively in 70 patients for lymph node staging. Postoperative patholog ic findings served as a criterion standard. Setting: An academic medical center. Results: The diagnostic accuracy of PET for detecting "neck sides" with mal ignant involvement was superior to morphologic procedures, with a sensitivi ty and specificity of 87% and 94%, respectively, compared with computed tom ographic values of 65% and 47% and magnetic resonance reimaging-values of 8 8% and 41%, respectively. Conclusion: A short PET protocol that is suitable for routine clinical use is superior to morphologic procedures (computed tomography and magnetic res onance imaging) for the detection of lymph node involvement in head and nec k squamous cell carcinomas.