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RESULTS: For the detection of locoregional persistent or recurrent HNSCC, PET scans had a sensitivity of 82%, specificity of 92%, positive predictive value (PPV) of 64%, negative predictive value (NPV) of 97%, and overall accuracy of 90%. For the detection of distant metastases, PET scans had a sensitivity of 89%, specificity of 97%, PPV of 85%, NPV of 98%, and overall accuracy of 96%. PET scans of the head and neck region performed greater than 1 month after the completion of radiation compared with scans performed within 1 month had a significantly higher sensitivity of 95% versus 55% (P < .01) and NPV of 99% versus 90% (P < .01).

CONCLUSION: PET is effective in detecting distant metastases in the posttreatment surveillance for HNSCC patients. A negative PET is highly reliable for all sites. However, a positive PET in the head and neck region is unreliable because of a high false-positivity rate. PET of the head and neck region has a statistically significant risk of a false-negative reading when performed within 1 month of radiation.

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NEW YORK SEPT 06, 2007 (Reuters Health) - Positron emission tomography-computed tomography using fluorodeoxy-glucose F 18 (FDG-PET/CT) provides early, accurate detection of bone metastases from head and neck squamous cell carcinoma, researchers report in the August issue of Archives of Otolaryngology, Head and Neck Surgery.

Dr. Brian Nussenbaum of Washington University School of Medicine, St. Louis, Missouri and colleagues evaluated 13 head and neck squamous cell carcinoma patients with FDG-PET/CT findings suggestive of metastases.

These patients were identified by retrospective review of data from 683 patients with head and neck squamous cell carcinoma who had undergone the procedure during initial staging or restaging.

All of the 13 patients lacked clinical symptoms of bone involvement and 9 had serum alkaline phosphatase levels in the normal or minimally elevated range.

Five patients underwent bone biopsy and 4 were confirmed as having metastasis. The fifth patient was found to have Rosai-Dorfman bone disease, a rare non-malignant condition, and was excluded from further analysis.

In the remaining 12 patients, FDG-PET/CT identified a total of 27 bone lesions. At the time of metastasis identification, 6 of the patients had no other identifiable distant metastatic disease and 2 of these lacked disease at any other site. The findings influenced therapeutic decision making in 5 patients.

The study "further shows the utility of obtaining PET/CT imaging for radiographically restaging patients with head and neck carcinoma," Dr. Nussenbaum told Reuters Health.

SOURCE: Arch Otolaryngology Head Neck Surg 2007;133:801-805.

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• BACKGROUND: We assessed the role of (18)F-fluoro-deoxy-glucose positron emission tomography (PET) in detecting head and neck squamous cell carcinoma (HNSCC) after definitive chemoradiotherapy (CRT).
• METHODS: A prospective study presented 80 PET before and after CRT for 44 patients, including 44 first-time post-CRT scans performed between 12 and 17 weeks after radiotherapy completion, as well as 10 repeated scans in the subsequent follow-up. PET interpretations were compared with clinicopathologic outcomes.
• RESULTS: PET demonstrated better performance than CT in post-CRT surveillance. Considering all 54 post-CRT PET scans, sensitivity for detecting primary tumors was 100%, specificity 93%, positive predictive value (PPV) 80%, and negative predictive value (NPV) 100%. For cervical diseases, sensitivity was 100%, specificity 98%, PPV 92%, and NPV 100%. For distant metastases, sensitivity was 100%, specificity 98%, PPV 86%, and NPV 100%.
• CONCLUSIONS: Negative PET readings were reliable for predicting free of HNSCC and helpful for selected patients in post-CRT surveillance.

(c) 2009 Wiley Periodicals, Inc. Head Neck, 2009.