Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient
Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient
复制标题
DOI：
10.1097/00005537-200009000-00016
复制
发表时间：
2000-09-01
期刊：
影响因子：
2.6
通讯作者：
Pauwels, S
中科院分区：
文献类型：
--
作者：
Lonneux, M;Lawson, G;Pauwels, S
目的：分析氟代脱氧葡萄糖正电子发射断层扫描(FDG-PET)在头颈部肿瘤复发患者治疗中的作用。研究设计：前瞻性连续纳入44例临床症状提示头颈部肿瘤复发的患者。方法：比较FDG-PET与CT+MRI联合检查对肿瘤复发与治疗后良性病变的鉴别诊断价值。对于FDG-PET，研究了半定量指标的潜在附加值。回顾分析了CT+MRI和PET检查对患者治疗的影响(即他们准确选择患者进行泛内窥镜探查的能力)。结果：正电子发射计算机体层摄影的诊断准确率高于CT-MRI，其敏感度为96%~73%，特异度为61%~50%，准确率为81%~%。在治疗结束12周以上的患者中，FDG-PET的准确率最高(94%)。在15例不一致的病例中，11例PET正确，4例CT+MRI正确。在FDG-PET和CT+MRI的患者中，分别有79%和50%的患者选择全内窥镜探查和活检是正确的，FDG摄取的量化与视觉分析相比没有额外的价值，尽管我们发现SWlbm(针对瘦体质量校正的标准摄取值)阈值3可能有助于治疗结束后12周内扫描的患者。结论：FDG-PET对疑似头颈癌复发的症状性患者的诊断价值高于CT+MRI。PET可以通过正确选择需要行全内窥镜探查和活检的患者，对治疗产生直接影响。
Objective: To analyze the impact of positron emission tomography with fluorodeoxyglucose (FDG-PET) in the treatment of patients suspected of having head and neck cancer recurrence. Study Design: Prospective and consecutive inclusion of 44 patients presenting with clinical symptoms suggestive of head and neck tumor recurrence. Methods: FDG-PET was compared with combined computed tomography (CT) plus magnetic resonance imaging (MRI) procedures for the differential diagnosis between tumor recurrence and benign post-therapeutic changes. For FDG-PET, the potential additional value of semiquantitative indexes was studied. The impact on patient treatment (i.e., their ability to accurately select patients for panendoscopic exploration) was analyzed retrospectively for both CT+MRI and PET workups. Results: The diagnostic accuracy was found higher for PET than for combined CT-MRI: sensitivity ranged from 96% to 73%, specificity from 61% to 50%, and accuracy from 81% to 64% for PET and CT+MRI, respectively. The accuracy of FDG-PET was the highest (94%) in patients included more than 12 weeks after the end of therapy. In 15 discordant cases, PET was correct in 11 and CT+MRI in 4. Patient selection for panendoscopic exploration and biopsy was correct in 79% and 50% of patients with FDG-PET and CT+MRI, respectively, Quantification of FDG uptake had no additional value over visual analysis alone, although we found that a SWlbm (standardized uptake value corrected for lean body mass) threshold of 3 could be helpful in patients scanned less than 12 weeks after the end of therapy. Conclusion: FDG-PET has a major additional diagnostic value to CT+MRI for the evaluation of the symptomatic patient suspected of having head and neck cancer recurrence. PET could have a direct impact on management by correctly selecting patients in whom a panendoscopic exploration with biopsy is indicated.