방사선의학 웹진

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Abstract
Purpose: This study aimed to evaluate the diagnostic performance of surveillance FDG PET/CT for detection of clinically unexpected recurrent disease or second primary malignancy in head and neck squamous cell carcinoma (HNSCC) patients who underwent curative treatment.

Patients and methods: We conducted a retrospective analysis of 739 consecutive patients with HNSCC who underwent 2396 surveillance FDG PET/CT scans. Surveillance FDG PET/CT scans were defined as routine follow-up scans after curative therapy without suspicion of recurrence. The diagnostic performance of FDG PET/CT was evaluated based on sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Results: Of the 2396 surveillance FDG PET/CT scans, 119 (5.0%) showed positive findings, with 93 (78.1%) confirmed as true-positives. True-positive detections included locoregional metastases, distant metastases, or second primary malignancies. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.9%, 98.9%, 78.2%, 99.9%, and 98.8%, respectively. The incidence of recurrence was significantly greater in patients initially diagnosed with stage IVA disease (P = 0.03) and for which 5 or more years had elapsed since treatment (P < 0.001) than in other subgroups. However, no significant differences in diagnostic performance were observed across subgroups divided by tumor location, disease stage, treatment modality, or time since treatment.

Conclusions: Surveillance FDG PET/CT showed excellent diagnostic performance for detection of clinically unexpected recurrent disease or second primary malignancies in patients with HNSCC after curative therapy. The frequency and duration of surveillance could be adjusted based on the initial disease stage to optimize early detection and intervention.

HNSCC로 근치적 치료를 받은 서로 다른 환자에서 촬영한 surveillance FDG PET/CT의 MIP (위), transaxial fusion (아래) 영상으로, (a) 후두의 국소 재발, (b) 폐의 원격 전이, (c) 식도에 발생한 이차암 소견을 surveillance FDG PET/CT를 이용해 성공적으로 진단했습니다.

Affiliations

Wonseok Whi 1, Seung Hwan Moon 1, Dongryul Oh 2, Man Ki Chung 3, Han-Sin Jeong 3, Myung Ju Ahn 4, Joon Young Choi 1
1From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
3Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
4Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.