Comparison of thallium-201 and F-18 FDG SPECT uptake in squamous cell carcinoma of the head and neck.

PURPOSETo compare the uptake of 2-[F-18] fluoro-2-deoxy-D-glucose (fludeoxyglucose F-18; F-18 FDG) and thallous chloride Tl 201, using single-photon emission CT (SPECT), for the detection and location of squamous cell carcinoma of the head and neck.METHODSFive patients with biopsy-proved squamous cell carcinoma of the upper aerodigestive tract underwent both F-18 FDG and thallium-201 SPECT on the same day. F-18 FDG SPECT was performed using a dual-head gamma camera equipped with commercially available, extremely high-energy collimators (full width half-maximal height, 17 mm for 511 keV photons). Tumor size was estimated at 1.0 to 5.0 cm3 in these cases.RESULTSF-18 FDG SPECT showed five of five primary tumors. In two of the five cases, normal salivary gland activity severely limited thallium SPECT, and the tumors could not be definitively identified. Two of four lymph node groups that were positive for metastatic disease by CT criteria were shown by F-18 FDG SPECT. None were seen with thallium imaging. In one case, F-18 FDG SPECT was able to show a tumor that was not visible on CT.CONCLUSIONSF-18 FDG has advantages over Tl-201 as a squamous cell carcinoma imaging agent (primarily because of its reduced salivary activity). F-18 FDG SPECT has potential as a viable, less expensive alternative to F-18 FDG positron emission tomography. The ultimate value of F-18 FDG SPECT imaging for detecting occult malignancy, monitoring therapeutic effectiveness, or evaluating tumor recurrence remains to be determined in patients with squamous cell carcinoma of the head and neck.     

Evaluation of recurrent squamous cell carcinoma of the head and neck with FDG positron emission tomography

PURPOSE: This study compared the effectiveness of fluorodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography (CT), magnetic resonance imaging (MRI), or both for the assessment of recurrent squamous cell carcinoma of the head and neck. The value of quantifying the standardized uptake values (SUV) to distinguish recurrent neoplasm from inflammatory lesions and normal structures was also evaluated. METHODS: Forty-three patients with head and neck cancer were examined with F-18 FDG PET at least 4 months after their last course of radiation therapy (mean, 11 months). The SUVs were measured in visually identified regions of abnormally increased activity and were compared with the values in normal mucosa, the base of the tongue, and the hard palate to determine if an optimal cutoff value exists for diagnosing recurrence of malignant lesions. The final diagnosis of recurrence was made based on biopsy or at least 6 months' clinical follow-up. RESULTS: FDG PET correctly detected recurrence in 20 of 22 patients who had 45 discrete lesions located in the field of the upper aerodigestive tract. Two false-negative and three false-positive results were identified. The accuracy of FDG PET was 88% (38 of 43 patients), compared with 66% (25 of 38 patients) for CT, MRI, or both. Although there was a significant difference of SUVs (P = 0.0036) between the recurrent lesions and normal structures, the optimal cutoff values were difficult to define. CONCLUSIONS: Visual analysis of FDG PET is significantly more accurate in the diagnosis of recurrent squamous cell cancer of the head and neck than are CT or MRI. However, single SUV quantification does not significantly enhance efficacy.     

Prognostic value of volumetric parameters measured by 18F-FDG PET/CT in patients with head and neck squamous cell carcinoma

Purpose

The objective of this study was to investigate the value of metabolic tumour volume (MTV) assessed with ¹⁸F-FDG PET/CT in predicting event-free survival (EFS) and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC), and particularly to compare it with more conventional parameters such as maximum standardized uptake value (SUVmax).

Methods

Patients referred to our department for ¹⁸F-FDG PET/CT for staging of HNSCC were prospectively included between February 2009 and March 2011. Each patient was scanned using a Philips Gemini PET/CT system at 1 h after injection. The MTV was calculated semiautomatically for the primary site using methods based on SUV with various thresholds: 3-D contour around voxels equal to or greater than 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5 and 7.0 times SUV, or more than 30 %, 40 % and 50 % of SUVmax. ROC analysis was used to test the statistical significance of the differences among the calculated MTVs. EFS and OS were determined using the Kaplan-Meier method and compared with MTV in univariate and multivariate analyses, including the usual prognostic factors: age, sex, primary site, treatment, SCC histologic grade, AJCC stage, TNM classification, tumour SUVmax and SUVpeak.

Results

The study included 80 consecutive patients (70 men, 10 women; mean age 62.4?±?9.0 years). ROC analysis revealed that pretreatment MTV using a threshold of 5.0 times SUV (MTV5.0) was the best parameter to predict recurrence and death after treatment. In univariate analysis, MTV5.0 >4.9 ml was predictive of poor EFS (p?<?0.0001) and poor OS (p?<?0.0001). In multivariate, MTV5.0 persisted as an independent predictive factor for EFS (p?=?0.011) and OS (p?=?0.010), while SUVmax became nonsignificant (p?=?0.277 for EFS, p?=?0.975 for OS).

Conclusion

Our results suggest that MTV measured by ¹⁸F-FDG PET/CT has independent prognostic value of in patients with HNSCC, stronger than SUVmax.     

Clinical values for abnormal F-FDG uptake in the head and neck region of patients with head and neck squamous cell carcinoma

Purpose

Fluorine 18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) is used to identify index or second primary cancer (SP) of the head and neck (HN) through changes in ¹⁸F-FDG uptake. However, both physiologic and abnormal lesions increase ¹⁸F-FDG uptake. Therefore, we evaluated ¹⁸F-FDG uptake in the HN region to determine clinical values of abnormal tracer uptake.

Methods

A prospective study approved by the institutional review board was conducted in 314 patients with newly diagnosed HN squamous cell carcinoma (HNSCC) and informed consent was obtained from all enrolled patients. The patients received initial staging workups including ¹⁸F-FDG PET/CT and biopsies. All lesions with abnormal HN ¹⁸F-FDG uptake were recorded and most of those were confirmed by biopsies. Diagnostic values for abnormal ¹⁸F-FDG uptake were calculated.

Results

Abnormal ¹⁸F-FDG uptake was identified in primary tumors from 285 (91.9%) patients. False-negative results were obtained for 22.3% (23/103) T1 tumors and 2.2% (2/93) T2 tumors (P < 0.001). Thirty-eight regions of abnormal ¹⁸F-FDG uptake were identified in 36 (11.5%) patients: the thyroid (n = 13), maxillary sinus (n = 7), palatine tonsil (n = 6), nasopharynx (n = 5), parotid gland (n = 2) and others (n = 5). Synchronous SP of the HN was identified in eight (2.5%) patients: the thyroid (n = 5), palatine tonsil (n = 2), and epiglottis (n = 1). The sensitivity and specificity of ¹⁸F-FDG PET/CT for identification of SPs were 75.0% and 98.7%, respectively.

Conclusions

¹⁸F-FDG PET/CT is a reliable method for tumor staging and identify SP in HN region, promoting appropriate therapeutic planning. Additional examinations may be required to identify superficial or small-volume tumors.     

Role of DW-MRI and ADC value in monitoring therapy of head and neck squamous cell carcinoma

Aim

To evaluate role of DW-MRI and ADC value in monitoring therapy of head and neck squamous cell carcinoma (HNSCC).

Prognostic value of <Superscript>99m</Superscript>Tc-HYNIC Annexin-V imaging in squamous cell carcinoma of the head and neck

Purpose The purpose of the study was to report on the prognostic value of ^99mTc-hydrazinonicotinamide (HYNIC) Annexin-V single-photon emission computed tomography (SPECT) imaging in patients suffering from primary squamous cell carcinoma of the head and neck. Methods Twenty-nine patients diagnosed with a primary untreated head and neck squamous cell carcinoma were included in this study. In all patients, ^99mTc-HYNIC Annexin-V scintigraphy SPECT was performed before treatment instigation. Tumour-to-background ratios (T/N) of the primary tumour, derived from reconstructed images, as well as clinical variables were obtained in all patients and related to patient outcome. Median follow-up was 22.6 months (range 4.1–55.8 months). Results On univariate as well as multivariate analysis, only the ^99mTc-HYNIC Annexin-V T/N ratio dichotomized using the group median as cutoff value (T/N ratio of 2) was predictive of recurrence-free survival (respectively, p = 0.0000 and 0.000). On univariate analysis, only lymph node status dichotomized according to N0 vs N1–N2–N3 disease and the ^99mTc-HYNIC Annexin-V T/N ratio dichotomized using the group median as cutoff value (T/N ratio of 2) were predictive of overall survival (p = 0.0051 and 0.0000). When both factors were included in the multivariate model, both N status and the ^99mTc-HYNIC Annexin-V T/N ratio showed an independent association with overall survival (p = 0.001 for lymph node status and 0.000 for dichotomized ^99mTc-HYNIC Annexin-V T/N ratio). Conclusion ^99mTc-HYNIC Annexin-V T/N ratios derived from SPECT provides independent prognostic information on disease-free survival and overall survival.     

A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity

Objective  

In clinical positron emission tomography (PET) studies for oncology, it is occasionally required to differentiate a diffuse increase in bone marrow (BM) F-18 fluoro-2-deoxyglucose (FDG) uptake due to the involvement of malignancy or hematopoietic disease and that due to the administration of hematopoietic cytokines, an inflammation reaction, or stimulation by some types of malignancy. The objectives of this study were to clarify the relationships between BM F-18 FDG uptake and blood parameters as well as age, and also to determine the degree of F-18 FDG accumulation that constitutes an abnormal level referring to blood parameters.     

Predictive value of diffusion-weighted magnetic resonance imaging during chemoradiotherapy for head and neck squamous cell carcinoma

Objective  

To evaluate diffusion-weighted (DWI) magnetic resonance imaging (MRI) for treatment prediction during chemoradiotherapy (CRT) of head and neck squamous cell carcinoma (HNC).     

Calcified nodal metastasis from squamous cell carcinoma of the head and neck

Calcification within cervical lymph nodes is relatively rare, and most commonly ascribed to benign inflammatory or infectious processes. We present a case of a calcified submandibular nodal metastasis from squamous cell carcinoma of the lip and review the current published literature on nodal calcifications in the neck. To the authors' knowledge, calcification resulting from metastatic squamous cell carcinoma of the head and neck has been described only once previously.     

<Superscript>123</Superscript>I-Interleukin-2 uptake in squamous cell carcinoma of the head and neck carcinoma

Introduction Information obtained on the IL-2 receptor status of tumour infiltrating lymphocytes in patients suffering from squamous cell carcinoma of the head and neck (SSCHN) before and after IL-2 treatment may lead to a better understanding of the immunological changes and related kinetics induced at the tumour level and ultimately to a strategy that allows selection of those patients that will benefit from IL-2 therapy. This study set out to assess the relationship between ¹²³I-IL2 single-photon emission computed tomography (SPECT) findings and the presence of IL-2 receptors (CD25 staining) on tumour-infiltrating lymphocytes as well as on SCCHN tumour cells in patients suffering from SCCHN. Materials and methods Seventeen consecutive patients (12 men; mean age, 57 years) highly suspected to suffer from SSCHN were prospectively included in the study. All patients underwent planar and whole body ¹²³I-IL2 scintigraphy and underwent surgery or had a biopsy taken within 1 week from imaging. Surgical resected primary lesions as well as biopsy material from primary tumours were histologically analysed with respect to the presence and intensity of CD25 expression on tumour infiltrating lymphocytes and tumour cells (HSCORE). Tumor-to-background (T/N) ratios of the primary tumour derived from planar and tomographic ¹²³I-IL2 scintigraphy were related to the results derived from histology. Results All patients suffered from SSCHN. T/N ratios derived from SPECT images were significantly correlated with CD25 lymphocyte HSCOREs (r = 0.66; p = 0.03), but not with CD25 tumour cell HSCOREs. Conclusions ¹²³I-IL-2 SPECT imaging allows for non-invasive imaging of the relative amount of IL-2 receptors present on tumour infiltrating lymphocytes in SCCHN.     

Prognostic importance of lymph node-to-primary tumor standardized uptake value ratio in invasive squamous cell carcinoma of uterine cervix

Purpose

Using integrated PET/CT, we evaluated the prognostic value of [¹⁸F]FDG uptake ratio between pelvic lymph node (LN) and primary tumor in invasive squamous cell carcinoma (SCCA) of the uterine cervix.

Methods

We retrospectively reviewed patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB to IIA cervical SCCA who underwent preoperative [¹⁸F]FDG PET/CT scans. PET/CT parameters such as maximum standardized uptake value (SUV) of the primary cervical cancer (SUV_cervix) and LN (SUV_LN), and the LN-to-cervical cancer SUV ratio (SUV_LN/SUV_cervix) were assessed. Prognostic values of PET/CT-derived metabolic and volumetric variables and clinicopathology parameters were analyzed to predict progression-free survival (PFS) in regression analyses.

Results

Clinical data, treatment modalities, and results were reviewed for 103 eligible patients. Median post-surgical follow-up was 29 months (range, 6–89), and 19 (18.5%) patients experienced recurrence. Multivariate logistic regression analysis showed that SUV_LN / SUV_cervix > 0.1747(P = 0.048) was the independent risk factor of recurrence. Patient group categorized by SUV_LN/SUV_cervix showed significant difference in PFS (log-rank test, P < 0.001).

Conclusions

Preoperative SUV_LN/SUV_cervix measured by [¹⁸F]FDG PET/CT was significantly associated with recurrence, and has an incremental prognostic value for PFS in patients with cervical SCCA.