Response evaluation of cervical lymph nodes after chemoradiation in patients with head and neck cancer - does additional
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RESEARCH ARTICLE
Open Access
Response evaluation of cervical lymph nodes after chemoradiation in patients with head and neck cancer - does additional [18F]FDG-PET-CT help? Daniel Dejaco1, Christian Uprimny2, Gerlig Widmann3, David Riedl4, Patrizia Moser5, Christoph Arnold6, Teresa Bernadette Steinbichler1, Barbara Kofler1, Volker Hans Schartinger1* , Irene Virgolini2 and Herbert Riechelmann1
Abstract Background: Contrast-enhanced high-resolution computed tomography (contrast-CT) is a standard imaging modality following primary concurrent radiochemotherapy (RCT) for response evaluation in patients with head and neck squamous cell carcinoma (HNSCC). We investigated the additional benefit of Fluorine-18-fluorodeoxyglucose ([18F]FDG) - positron emission tomography with computed tomography (PET-CT), if complete response (CR) in the neck based on contrast-CT was considered unsafe by the interdisciplinary tumor board (ITB). Methods: In a retrospective observational study, patients recorded in the institutional tumor registry with incident advanced HNSCC following first line treatment with RCT were eligible. If contrast-CT results of the neck were equivocal or positive at response evaluation, a neck dissection (ND) was scheduled. While waiting for the ND, a [18F]FDG-PET-CT was performed in addition. The histopathological outcome of ND served as reference criterion. Accuracy parameters including sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for both, contrast-CT and PET-CT, served as main outcome parameters. Results: A total of 41 HNSCC patients with positive or equivocal posttreatment contrast-CT were eligible for postRCT-ND. Of these, 33 received an additional [18F]FDG-PET-CT prior to surgery. Median interval between completion of RCT and the ([18F]FDG)-PET-CT was 10 weeks. Vital persistent tumor in the neck was histopathologically found in 13 of 33 patients with positive or equivocal posttreatment contrast-CT. For contrast-CT and [18F]FDG-PET-CT, sensitivity was 92.3 and 69.2% and did not differ statistically significantly (p = 0.250) whereas specificity was significantly higher for [18F]FDG-PET-CT compared with contrast-CT (80% vs. 25%, p = 0.001). For contrast-CT and [18F]FDG-PET-CT accuracy, PPV and NPV was 31.7, 12.0,96.7 and 78.9, 27.8,95.0%, respectively. (Continued on next page)
* Correspondence: [email protected] 1 Department of Otorhinolaryngology – Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this arti
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