To evaluate the diagnostic accuracy of positron emission tomography (PET) and PET/computed tomography (CT) for detecting residual and/or recurrent local and regional disease and distant metastases in patients with head and neck squamous cell carcinomas (HNSCCs) following radiotherapy with or without chemotherapy.
Data Sources
A systematic review with no language restrictions was conducted using PREMEDLINE, MEDLINE, EMBASE, and Google Scholar.
Review Methods
Only prospective studies with histopathological and/or clinical follow-up that assessed the diagnostic accuracy of PET and PET/CT in detecting residual and/or recurrent disease following radiotherapy with or without chemotherapy in patients with HNSCCs were included.
Results
Twenty-seven studies were identified. The pooled sensitivity and specificity of PET and PET/CT for detecting residual or recurrent disease at the primary site was 86.2% and 82.3%, respectively. For residual and recurrent neck disease, the sensitivity and specificity were 72.3% and 88.3%, while for distant metastases, the values were 84.6% and 94.9%.
Conclusions
PET and PET/CT are highly accurate in detecting residual and/or recurrent HNSCC. PET/CT is more specific than PET alone. Specificity is also greater for scans performed more than 12 weeks after radiotherapy with or without chemotherapy. The authors support the use of PET/CT after 12 weeks posttreatment for the assessment of residual or recurrent disease.
CuradoMPHashibeM. Recent changes in the epidemiology of head and neck cancer. Curr Opin Oncol. 2009;21:194-200.
2.
MarurSForastiereAA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clinic Proc. 2008;83:489-501.
3.
GregoireVLefebvreJLLicitraLFelipE. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(suppl 5):v184-v186.
4.
AngKKTrottiABrownBW. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;51:571-578.
5.
KonessRJGlicksmanALiuL. Recurrence patterns with concurrent platinum-based chemotherapy and accelerated hyperfractionated radiotherapy in stage III and IV head and neck cancer patients. Am J Surg. 1997;174:532-535.
6.
GourinCGWattsTLWilliamsHTPatelVSBilodeauPAColemanTA. Identification of distant metastases with positron–emission tomography-computed tomography in patients with previously untreated head and neck cancer. Laryngoscope. 2008;118:671-675.
7.
PerlowABuiCShrevePSundgrenPCTeknosTNMukherjiSK. High incidence of chest malignancy detected by FDG PET in patients suspected of recurrent squamous cell carcinoma of the upper aerodigestive tract. J Comput Assist Tomogr. 2004;28:704-709.
8.
LeemansCRTiwariRNautaJJvan der WaalISnowGB. Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor. Cancer. 1994;73:187-190.
9.
SalaunPYAbgralRQuerellouS. Does 18fluoro-fluorodeoxyglucose positron emission tomography improve recurrence detection in patients treated for head and neck squamous cell carcinoma with negative clinical follow-up?Head Neck. 2007;29:1115-1120.
10.
WhitingPRutjesAWDinnesJReitsmaJBossuytPMKleijnenJ. Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess. 2004;8:iii, 1-234.
11.
BrkovichVSMillerFRKarnadABHusseyDHMcGuffHSOttoRA. The role of positron emission tomography scans in the management of the N-positive neck in head and neck squamous cell carcinoma after chemoradiotherapy. Laryngoscope. 2006;116:855-858.
12.
CeulemansGVoordeckersMFarragAVerdriesDStormeGEveraertH. Can 18-FDG-PET during radiotherapy replace post-therapy scanning for detection/demonstration of tumor response in head-and-neck cancer?Int J Radiat Oncol Biol Phys. 2011;81:938-942.
13.
ChaikenLRegeSHohC. Positron emission tomography with fluorodeoxyglucose to evaluate tumor response and control after radiation therapy. Int J Radiat Oncol Biol Phys. 1993;27:455-464.
14.
ConessaCFoehrenbachHHervéSPoncetJ-L. FDG-PET scan in local follow-up of irradiated head and neck squamous cell carcinomas. Ann Otol Rhinol Laryngol. 2004;113:628-635.
15.
FakhryNJacobTParisJ. Contribution of 18-F-FDG PET for detection of head and neck carcinomas with an unknown primary tumor. Ann Otolaryngol Chir Cervicofac. 2006;123:17-25.
16.
GoerresGWHaenggeliCAAllaouaM. Direct comparison of F-18-FDG PET and ultrasound in the follow-up of patients with squamous cell cancer of the head and neck. Nuklearmedizin. 2000;39:246-250.
17.
GoerresGWSchmidDTBandhauerF. Positron emission tomography in the early follow-up of advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 2004;130:105-109.
18.
GuptaTJainSAgarwalJP. Diagnostic performance of response assessment FDG-PET/CT in patients with head and neck squamous cell carcinoma treated with high-precision definitive (chemo) radiation. Radiother Oncol. 2010;97:194-199.
19.
InoharaHEnomotoKTomiyamaY. The role of CT and 18F-FDG PET in managing the neck in node-positive head and neck cancer after chemoradiotherapy. Acta Otolaryngol. 2009;129:893-899.
20.
ItoKYokoyamaJKubotaKMorookaMShiibashiMMatsudaH. 18F-FDG versus 11C-choline PET/CT for the imaging of advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy: the time period during which PET/CT can reliably detect non-recurrence. Eur J Nucl Med Mol Imaging. 2010;37:1318-1327.
21.
KimSYLeeS-WNamSY. The feasibility of 18F-FDG PET scans 1 month after completing radiotherapy of squamous cell carcinoma of the head and neck. J Nucl Med. 2007;48:373-378.
22.
KishinoTHoshikawaHNishiyamaYYamamotoYMoriN. Usefulness of 3′-deoxy-3′-18F-fluorothymidine PET for predicting early response to chemoradiotherapy in head and neck cancer. J Nucl Med. 2012;53:1521-1527.
23.
KitagawaYNishizawaSSanoK. Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med. 2003;44:198-206.
24.
KubotaKYokoyamaJYamaguchiK. FDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT. Eur J Nucl Med Mol Imaging. 2004;31:590-595.
25.
LiPZhuangHMozleyPD. Evaluation of recurrent squamous cell carcinoma of the head and neck with FDG positron emission tomography. Clin Nucl Med. 2001;26:131-135.
26.
McCollumADBurrellSCHaddadRI. Positron emission tomography with 18F-fluorodeoxyglucose to predict pathologic response after induction chemotherapy and definitive chemoradiotherapy in head and neck cancer. Head Neck. 2004;26:890-896.
27.
MoellerBJRanaVCannonBA. Prospective risk-adjusted [18F] fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. J Clin Oncol. 2009;27:2509-2515.
28.
MoriMTsukudaMHoriuchiC. Efficacy of fluoro-2-deoxy-D-glucose positron emission tomography to evaluate responses to concurrent chemoradiotherapy for head and neck squamous cell carcinoma. Auris Nasus Larynx. 2011;38:724-729.
29.
NamSYLeeS-WImKC. Early evaluation of the response to radiotherapy of patients with squamous cell carcinoma of the head and neck using 18 FDG-PET. Oral Oncol2005;41:390-395.
30.
NayakJVWalvekarRRAndradeRS. Deferring planned neck dissection following chemoradiation for stage IV head and neck cancer: the utility of PET-CT. Laryngoscope. 2007;117:2129-2134.
31.
NgS-HChanS-CYenT-C. PET/CT and 3-T whole-body MRI in the detection of malignancy in treated oropharyngeal and hypopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2011;38:996-1008.
32.
PorcedduSVJarmolowskiEHicksRJ. Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo) radiotherapy in head and neck cancer. Head Neck. 2005;27:175-181.
33.
RegeSMaassAChaikenL. Use of positron emission tomography with fluorodeoxyglucose in patients with extracranial head and neck cancers. Cancer. 1994;73:3047-3058.
34.
RogersJWGrevenKMMcGuirtWF. Can post–rt neck dissection be omitted for patients with head-and-neck cancer who have a negative pet scan after definitive radiation therapy?Int J Radiat Oncol Biol Phys. 2004;58:694-697.
35.
SjovallJBrunEAlmquistHKjellenEWahlbergP. Radiotherapy response in head and neck cancer: evaluation of the primary tumour site. Acta Otolaryngol. 2014;134:646-651.
36.
WangYFLiuRSChuPY. Positron emission tomography in surveillance of head and neck squamous cell carcinoma after definitive chemoradiotherapy. Head Neck. 2009;31:442-451.
37.
YenTCLinCYWangHM. 18F-FDG-PET for evaluation of the response to concurrent chemoradiation therapy with intensity-modulated radiation technique for Stage T4 nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006;65:1307-1314.
38.
GuptaTMasterZKannanS. Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2011;38:2083-2095.
39.
IslesMGMcConkeyCMehannaHM. A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol. 2008;33:210-222.
40.
GaoSLiSYangXTangQ. 18FDG PET-CT for distant metastases in patients with recurrent head and neck cancer after definitive treatment: a meta-analysis. Oral Oncol. 2014;50:163-167.
41.
FakhryNLussatoDJacobTGiorgiRGiovanniAZanaretM. Comparison between PET and PET/CT in recurrent head and neck cancer and clinical implications. Eur Arch Otorhinolaryngol. 2007;264:531-538.
42.
IshikitaTOriuchiNHiguchiT. Additional value of integrated PET/CT over PET alone in the initial staging and follow up of head and neck malignancy. Ann Nucl Med. 2010;24:77-82.
43.
ChanJYSanguinetiGRichmonJD. Retrospective review of positron emission tomography with contrast-enhanced computed tomography in the posttreatment setting in human papillomavirus–associated oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2012;138:1040-1046.
44.
HalpernBSYeomKFuegerBJLufkinRBCzerninJAllen-AuerbachM. Evaluation of suspected local recurrence in head and neck cancer: a comparison between PET and PET/CT for biopsy proven lesions. Eur J Radiol. 2007;62:199-204.
45.
WongRJLinDTSchoderH. Diagnostic and prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol. 2002;20:4199-4208.
46.
KeyesJWJr.SUV: standard uptake or silly useless value?J Nucl Med. 1995;36:1836-1839.
47.
LapelaMEigtvedAJyrkkiöS. Experience in qualitative and quantitative FDG PET in follow-up of patients with suspected recurrence from head and neck cancer. Eur J Cancer. 2000;36:858-867.
48.
GhanooniRDelpierreIMagremanneM. 18F-FDG PET/CT and MRI in the follow-up of head and neck squamous cell carcinoma. Contrast Media Mol Imaging. 2011;6:260-266.
49.
GrevenKMWilliamsDWKeyesJW. Positron emission tomography of patients with head and neck carcinoma before and after high dose irradiation. Cancer. 1994;74:1355-1359.
50.
KimJWRohJLKimJS. 18F-FDG PET/CT surveillance at 3–6 and 12 months for detection of recurrence and second primary cancer in patients with head and neck squamous cell carcinoma. Br J Cancer. 2013;109:2973-2979.
51.
LonneuxMLawsonGIdeCBausartRRemacleMPauwelsS. Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient. Laryngoscope. 2000;110:1493-1497.
52.
PurohitBSAilianouADulguerovNBeckerCDRatibOBeckerM. FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging. 2014;5:585-602.
53.
LangoMNMyersJNGardenAS. Controversies in surgical management of the node-positive neck after chemoradiation. Semin Radiat Oncol. 2009;19:24-28.
54.
ZhouXH. Correcting for verification bias in studies of a diagnostic test’s accuracy. Stat Methods Med Res. 1998;7:337-353.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
