Positron emission tomography-computed tomography: a superior and one-stop shop modality for treated head and neck carcinoma compared with conventional tomography.

ABSTRACT

PURPOSE: The fusion imaging modality of positron-emission tomography-computed tomography (PET-CT) has emerged as an important modality in the management of recurrent head and neck tumors. The aims of this study were to assess the role of PET-CT in the detection of recurrence in treated head and neck squamous cell carcinoma (HNSCC) and compare neck PET-CT and contrast-enhanced computed tomography (CECT) in the detection of locoregional recurrence with histopathologic correlation. MATERIALS AND METHODS: The study design was prospective and the study consisted of patients with treated HNSCC referred to the Department of Radiology at Rajiv Gandhi Cancer Institute and Research Center for follow-up or for clinical suspicion of recurrence. PET-CT and CECT neck images were obtained to detect recurrence based on clinical suspicion or as routine follow-up. Comparison of CECT and PET-CT results was performed using receiver operating characteristics (ROC) curves for the detection of locoregional recurrence with histopathologic correlation. RESULTS: Fifty-eight patients with treated HNSCC underwent neck PET-CT and CECT to detect recurrence based on clinical suspicion or as routine follow-up. The sensitivity and specificity of PET-CT for the detection of locoregional recurrence were 100% and 97.37%, which were considerably higher than 85% and 71.05% when using CECT. The ROC curve and its analysis showed that regional PET-CT is superior to neck CECT in the detection of locoregional recurrence (P = .02). When considering recurrence at the metastatic site, the sensitivity and specificity of PET-CT were 100% and 97.06%. PET-CT also detected second primary tumors in 2 patients. CONCLUSION: PET-CT not only is superior to conventional CECT in the detection of recurrence at locoregional and lymph node sites, but also plays a role in the restaging of recurrent tumors and the detection of distant metastases and second primary tumors. PET-CT, if included in routine post-treatment HNSCC follow-up or in a protocol for suspected recurrence, may have a major impact on the management of patients after treatment of HNSCC.