Positron emission tomography in the diagnosis and management of head and neck tumours

Full text: The accurate staging of squamous cell carcinoma (SCC) of the head and neck is important as it guides prognosis and management. These tumours have a high uptake of 2-[18F]fluoro-2-deoxy-D-glucose (18FDG) and can be imaged using Positron Emission Tomography (PET). Our aim was to determine the clinical impact of PET in these patients. The case notes of patients referred for PET scans with head and neck cancer were reviewed retrospectively. PET scan results were compared to other imaging, particularly CT scans, clinical staging and results of surgery. Eighteen scans were performed on 17 patients (10 male, aged 37-73 years) using an ADAC C-PET plus scanner. Images were acquired using a specific emission/transmission protocol with increased scanning time over the head and neck region. The indications for PET imaging were: detection of an unknown primary tumour in patients with malignant cervical nodes (7 cases), staging of a known primary tumour (5 cases) and detection of recurrent disease (6 cases). PET identified the unknown primary tumour in 33% of cases. In staging, PET correctly identified the primary tumour in all patients compared to only 60% on CT scans and upgraded staging in 20%. In 30% of patients studied for possible recurrence PET correctly indicated no residual tumour despite residual mass on CT scan. In the overall group management was changed in 27% cases based on the PET scan result. These results confirm that PET is useful in the management of head and neck cancer. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc