Limitation of 2-deoxy-2-[F-18]fluoro- d -glucose positron emission tomography (FDG-PET) to detect early synchronous prim
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ORIGINAL ARTICLE
Limitation of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography (FDG-PET) to detect early synchronous primary cancers in patients with untreated head and neck squamous cell cancer Atsushi Hanamoto • Yukinori Takenaka • Eku Shimosegawa • Yoshifumi Ymamamoto • Tadashi Yoshii • Susumu Nakahara • Jun Hatazawa • Hidenori Inohara Received: 14 February 2013 / Accepted: 14 August 2013 / Published online: 25 August 2013 Ó The Japanese Society of Nuclear Medicine 2013
Abstract Objective Patients with head and neck squamous cell carcinoma (HNSCC) often develop synchronous multiple primary cancers. It is important to detect second primary cancer in HNSCC patients, because it influences treatment selection of primary cancer. The aim of this study was to evaluate the utility of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET) for detecting synchronous primary cancers at the initial staging of patients with HNSCC. Methods Three hundred and forty-seven patients with untreated HNSCC underwent FDG-PET with or without computed tomography fusion and other routine workups, including upper gastrointestinal Lugol chromoendoscopy, for the initial staging. We examined the prevalence of second primary cancer in these patients and the utility of PET. Results We identified 57 synchronous primary cancers in 53 patients, of which only 33 % were detected with PET. The most common site for the second primary cancer was the esophagus (49 %), followed by stomach (14 %) and head and neck (11 %). Most early-stage esophageal cancers and stomach cancers were detected using Lugol chromoendoscopy but not PET.
A. Hanamoto Y. Takenaka (&) Y. Ymamamoto T. Yoshii S. Nakahara H. Inohara Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan e-mail: [email protected] E. Shimosegawa J. Hatazawa Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Conclusion Although PET is useful for detecting synchronous primary cancers, it is not a sensitive technique for detecting early esophageal cancers and gastric cancers. Therefore, Lugol chromoendoscopy is indispensable for detecting synchronous upper gastrointestinal cancers in HNSCC patients. Keywords FDG-PET Head and neck cancer Second primary cancer Chromoendoscopy Synchronous esophageal cancer Synchronous gastric cancer
Introduction In patients with head and neck squamous cell cancer (HNSCC), there is a strong tendency for developing multiple primary cancers, especially in the aerodigestive tract, e.g., in mucous membranes of head and neck, and esophagus. These patients usually have a habit of smoking and drinking alcohol, which increases the incidence of multiple primary cancers [1–3]. To improve the survival rate of patients with HNSCC, early diagnosis and treatment of synchronous primary cancers are important [4, 5]. For the detection of
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