Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma

Joshua K. Cho, Thomas J. Ow, Andrew Y. Lee, Richard V. Smith, Nicolas F. Schlecht, Bradley A. Schiff, Andrew B. Tassler, Juan Lin, Renee M. Moadel, Ana Y. Valdivia, Tony Abraham, Edwin Gulko, Matthew Neimark, Berrin Ustun, Jacqueline A. Bello, Keivan Shifteh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design: Case series with chart review. Setting: Montefiore Medical Center, Bronx, New York. Subjects and Methods: Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results: Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT (P =.056, P =.001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT (P =.014, P =.024). No significant difference was found in overall accuracy (P =.33, P =.88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion: No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.

Original languageEnglish (US)
Pages (from-to)439-447
Number of pages9
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume157
Issue number3
DOIs
StatePublished - Sep 1 2017

Fingerprint

Fluorodeoxyglucose F18
Tomography
Neoplasm Metastasis
Neck Dissection
Carcinoma, squamous cell of head and neck
Positron Emission Tomography Computed Tomography
Radiology
Neck
Pathology
Sensitivity and Specificity

Keywords

  • contrast-enhanced CT
  • head and neck squamous cell carcinoma
  • neck dissection
  • nodal staging
  • PET/CT
  • preoperative imaging

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

@article{cb3352f2575b438593adb2a61e82fa59,
title = "Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma",
abstract = "Objective: Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design: Case series with chart review. Setting: Montefiore Medical Center, Bronx, New York. Subjects and Methods: Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results: Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT (P =.056, P =.001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT (P =.014, P =.024). No significant difference was found in overall accuracy (P =.33, P =.88). The overall agreement percentages between N stage called by imaging modality and pathology were 52{\%} and 55{\%} for PET/CT and CECT, respectively. Conclusion: No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.",
keywords = "contrast-enhanced CT, head and neck squamous cell carcinoma, neck dissection, nodal staging, PET/CT, preoperative imaging",
author = "Cho, {Joshua K.} and Ow, {Thomas J.} and Lee, {Andrew Y.} and Smith, {Richard V.} and Schlecht, {Nicolas F.} and Schiff, {Bradley A.} and Tassler, {Andrew B.} and Juan Lin and Moadel, {Renee M.} and Valdivia, {Ana Y.} and Tony Abraham and Edwin Gulko and Matthew Neimark and Berrin Ustun and Bello, {Jacqueline A.} and Keivan Shifteh",
year = "2017",
month = "9",
day = "1",
doi = "10.1177/0194599817703927",
language = "English (US)",
volume = "157",
pages = "439--447",
journal = "Otolaryngology - Head and Neck Surgery (United States)",
issn = "0194-5998",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma

AU - Cho, Joshua K.

AU - Ow, Thomas J.

AU - Lee, Andrew Y.

AU - Smith, Richard V.

AU - Schlecht, Nicolas F.

AU - Schiff, Bradley A.

AU - Tassler, Andrew B.

AU - Lin, Juan

AU - Moadel, Renee M.

AU - Valdivia, Ana Y.

AU - Abraham, Tony

AU - Gulko, Edwin

AU - Neimark, Matthew

AU - Ustun, Berrin

AU - Bello, Jacqueline A.

AU - Shifteh, Keivan

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objective: Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design: Case series with chart review. Setting: Montefiore Medical Center, Bronx, New York. Subjects and Methods: Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results: Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT (P =.056, P =.001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT (P =.014, P =.024). No significant difference was found in overall accuracy (P =.33, P =.88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion: No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.

AB - Objective: Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design: Case series with chart review. Setting: Montefiore Medical Center, Bronx, New York. Subjects and Methods: Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results: Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT (P =.056, P =.001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT (P =.014, P =.024). No significant difference was found in overall accuracy (P =.33, P =.88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion: No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.

KW - contrast-enhanced CT

KW - head and neck squamous cell carcinoma

KW - neck dissection

KW - nodal staging

KW - PET/CT

KW - preoperative imaging

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U2 - 10.1177/0194599817703927

DO - 10.1177/0194599817703927

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JO - Otolaryngology - Head and Neck Surgery (United States)

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