Objectives: To evaluate the clinical usefulness of FDG-PET (fluoro-2-deoxy-glucose-positron emission tomography) in the detection of lymph node involvement and recurrences in patients with head and neck cancer.
Study design: Retrospective review of 38 patients with biopsy-proven head and neck cancers who underwent clinical, computed tomography (CT), and FDG-PET examinations. Twenty-five patients were studied prior to therapy and 13 patients were evaluated for disease recurrence.
Methods: All patients were operated and clinical data, CT, and FDG-PET results were correlated with histopathological findings.
Results: All primary tumors in 25 patients were detected, with the exception of one small superficial localization of the epiglottis. Histopathological examination showed lymph node involvement in 10 patients; PET detected lymph node involvement in five. FDG-PET found one case of nodal disease not identified by clinical and CT examination. With so few cases, this could be anecdotal. Five false-negative results (microscopic lymph node involvement) and two false positives were noted. Twelve of 13 patients with recurrent disease were correctly identified with FDG-PET. FDG-PET was the only imaging technique to identify local recurrence in two patients and lymph node involvement in two others. One false-positive result occurred in a patient with a foreign body granuloma.
Conclusions: FDG-PET is a useful diagnostic modality for the detection of recurrent tumors and, in selected cases, precise lymph node involvement. The best way to further investigate the utility of clinical FDG-PET is in the follow-up of treated patients.