The Role of 18 F-FDG PET/CT for Evaluation of Cervical Metastatic Lymph Nodes in a Patient with Metallic Artifacts from
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CASE REPORT
The Role of 18F-FDG PET/CT for Evaluation of Cervical Metastatic Lymph Nodes in a Patient with Metallic Artifacts from Dental Prosthesis: a Case Report Joon Yeun Park 1
&
Yu Hyun Lee 2
Received: 5 June 2020 / Revised: 7 July 2020 / Accepted: 22 July 2020 # Korean Society of Nuclear Medicine 2020
Abstract Cervical metastasis of squamous cell carcinoma from an unknown primary site occurs in approximately 2–4% of head and neck tumor cases. Without identification of the primary site, proper management cannot be achieved, resulting in significant morbidity and a lower cure rate. For the primary site assessment, positron emission tomography/computed tomography (PET/CT) using the radiotracer 18F-fluorodeoxyglucose (FDG) is the imaging modality of choice and has been shown to be superior to CT alone. Here, we report a case of cervical metastasis of squamous cell carcinoma in an 82-year-old man. 18F-FDG PET/CT revealed a tongue-base lesion, although neck CT detected no lesions because of artifacts from dental prosthesis, which was suspected as the primary site. The final diagnosis was confirmed as tongue-base cancer with neck lymph node metastases through biopsy. These results suggest that 18F-FDG PET/CT is a valuable diagnostic tool in patients with cervical metastatic lymph nodes because it can demonstrate primary tumors in patients with dental prosthesis. Keywords Head and neck cancer . Neck lymph nodes . Unknown primary . Dental prosthesis . FDG PET/CT
Introduction A palpable neck mass is a relatively common head and neck complaint in patients visiting the hospital [1]. If the lesions are firm, fixed, and/or matted, they might be associated with a malignant neoplasm, particularly in the elderly population [2]. The diagnostic process of a suspected malignant neck mass should include examination by a physician, radiologic imaging, and a biopsy, if required, for diagnostic accuracy and proper management [3, 4]. In the case that histologically proven metastatic lymph nodes are detected and conventional diagnostic work-up reveals no primary detectable tumors, combined positron emission tomography/computed tomography (PET/CT) using the radiotracer 18F-fluorodeoxyglucose (FDG) is useful [5, 6].
* Joon Yeun Park [email protected] 1
Department of Nuclear Medicine, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
2
Department of Radiology, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
Here, we report a case of head and neck cancer detected on F-FDG PET/CT but not on CT because of metallic artifacts from dental prosthesis [7]. 18
Case Report An 82-year-old man visited our hospital because of a palpable right-sided neck mass for 2 months and was referred to the Department of Oncology for further evaluation. Physical examination revealed a large, firm, fixed mass on the right side of the neck. The patient was a 25-pack-year current-smoker and had no previous cancer history. On ultrasonography, an irregular marginated heterogeneous echoic mass, sized approximately 6.3 × 3.9 × 8.1 cm, wa
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