Diagnosis and staging of head and neck cancer - A comparison of modern imaging modalities (positron emission tomography, computed tomography, color-coded duplex sonography) with panendoscopic and histopathologic findings

Objective: To compare the clinical value of positron emission tomography (P ET) using fludeoxyglucose F 18, computed tomography (CT), color-coded duple x sonography (CCDS), and panendoscopy in the detection and staging of head and neck cancer. Design: Prospective nonrandomized controlled study. Setting: Medical school. Patients: Convenience sample of 50 patients with suspected primary or recur rent head and neck cancer. Intervention: Biopsy, tumor surgery. Main Outcome Measures: Information of diagnostic procedures compared with h istopathologic features. Results: Both PET and panendoscopy had a sensitivity of 95% and 100% for de tection of primary tumor or recurrent carcinomas, respectively. Specificity for PET and panendoscopy was 92% and 85% in primary tumors and 100% and 80 % in recurrent carcinoma, respectively. Sensitivity of CCDS and CT was 74% and 68% in primary tumors and 67% and 63% in recurrent carcinomas, respecti vely. Specificity was 75% and 69% in primary tumors and 100% and 80% in rec urrent neoplasms. When assessing neck nodes, all imaging procedures exhibit ed identical sensitivity (84%). Specificity was 90%, 96%, and 88% in PET, C T, and CCDS, respectively. In recurrent lymph node metastases, sensitivity was 100%, 67%, and 67% and specificity was 87%, 91%, and 87% for PET, CT, a nd CCDS, respectively. Conclusions: Positron emission tomography was the most reliable imaging pro cedure in the detection of primary tumor and recurrent carcinomas localized in the head and neck region. Owing to its limited anatomical depiction, it cannot as yet replace other diagnostic procedures in preoperative planning but does contribute valuable complementary diagnostic information. Compute d tomograpy may have difficulties in identifying recurrent carcinomas. For routine diagnosis of nodal spread in the neck, CCDS is recommended. Panendo scopy is a valuable diagnostic procedure that can provide key information i n cases of superficial mucosal tumor involvement.