Preoperative evaluation of patients with primary head and neck cancer using dual-head (18)fluorodeoxyglucose positron emission tomography

Objective To evaluate the value of (18)fluorodeoxyglucose (FDG) positron emission tom ography (PET) in primary head acid neck cancer. Background Data Head and neck carcinomas tend to metastasize to regional lymph nodes rather than to spread hematogenously. With nodal metastases, cure rates decrease by approximately 50%. Moreover, in approximately 3% of the patients, a seco nd primary tumor is found at initial presentation. Methods Fifty-four consecutive patients (31 men and 23 women; mean age 60 years, ra nge 34-81 years) with previously untreated squamous cell carcinomas of the oral cavity or oropharynx were studied. Before surgery and within a period of 3 weeks, clinical examination, chest x-ray, computed tomography (CT), ul trasonography with fine-needle aspiration cytology (US/ FNAC), and FDG-PET were performed. All study results were scored per neck side and were also c lassified as 0 (no metastases), 1 (single metastasis), or 2 (multiple metas tases). Results The sensitivity for the detection of lymph node metastases per neck side wa s 96%, 85%, and 64% for FDG-PET, CT, and US/FNAC, respectively. The specifi city was 90%, 86%, and 100% for FDG-PET, CT, and US/FNAC, respectively. In terms of the classification, FDG-PET showed the best correlation with the h istologic data. Finally, in nine patients (17%), a second primary tumor was detected by FDG-PET and confirmed by histologic evaluation, Conclusion Because of the high prevalence of second primary tumors detected by FDG-PET and the decreased error rate in the assessment of lymph node involvement c ompared with CT and US, FDG-PET should be routinely performed in patients w ith primary head and neck cancer.