Search

Objective Follow-up of patients with oral cavity squamous cell carcinoma (OCSCC) after tumor resection and reconstruction with tissue transfer is challenging. We compared contrast-enhanced computed tomography (ceCT), 18F-fluorodeoxyglucose-positron emission tomography combined with noncontrast enhanced CT (18F-FDG-PET/CT), and 18F-FDG-PET combined with ceCT (18F-FDG-PET/ceCT) to determine the accuracy for detection of residual/recurrent disease after flap reconstruction for OCSCC. Study Design and Methods Two readers (R1, R2) retrospectively reviewed a total of 27 18F-FDG-PET/ceCT scans in patients after resection of stage II to IV OCSCC. They recorded the presence of local persistence/recurrence (LR), lymph node metastasis, or distant metastasis independently for ceCT, 18F-FDG-PET/CT, and 18F-FDG-PET/ceCT. Histological workup, imaging follow-up, or clinical follow-up served as the standard of reference. Maximum standardized uptake value (SUVmax) was evaluated to discriminate between physiological uptake and LR. Results The highest accuracy to detect LR was achieved with 18F-FDG-PET/ceCT, with a sensitivity/specificity of 88%/89% and 88%/79% for R1 and R2, respectively, as compared to ceCT with 75%/79% for R1 and 88%/68% for R2 and 18F-FDG-PET/CT with 88%/58% for both R1 and R2. Receiver-operating-characteristic analysis determined a cutoff value for SUVmax of 7.2, yielding a sensitivity and specificity of 75% and 94%, respectively, to distinguish LR from physiological 18F-FDG uptake. Conclusion 18F-FDG-PET/ceCT seems to be the most reliable tool for locoregional surveillance of OCSCC patients after resection and reconstruction. Level of Evidence 4. Laryngoscope, 125:1861-1868, 2015 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The aim was to compare the value of 18-Fluoro-Deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) regarding contralateral lymph node (LN) metastasis in the neck. Study Design: Retrospective analysis of 61 patients staged by 18F-FDG-PET/CT. Methods: Cytology/histology served as a reference standard. Further, metabolic midline invasion (MI) of the primary tumor and the presence of bilateral LN metastases were assessed. Results: A true positive rate in the ipsilateral neck of 80% versus 65% in the contralateral neck was found (P = 0.067). Median-standardized uptake value (SUV)-max for suspicious LN ipsilaterally was 7.6 versus 5.8 contralaterally (P = 0.038). There was no positive correlation between metabolic MI and bilateral metastasis (P = 0.82). Conclusions: The rate of true positive detected LN by 18F-FDG-PET/CT is less on the contralateral neck side; therefore, all suspicious LNs should be verified by cytology. A high SUV in the contralateral neck suggests metastatic disease regardless of nodal size. Metabolic MI needs to be addressed carefully as it was not predictive for bilateral LN involvement. Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to assess the impact of 18F-fluoro-2-deoxy- D-glucose (18F-FDG) PET/CT on survival for patients with head and neck squamous cell carcinoma correlated with a matched patient cohort. Methods In all, disease in 58 patients was initially staged using 18F-FDG PET/CT. A case-control analysis was done with 63 patients who disease was staged without 18F-FDG-PET/CT. Results Disease-specific survival (DSS) and overall survival (OS) did not show significant differences between both groups. Statistical analysis revealed no difference in DSS and OS between the 2 groups for patients treated by radiochemotherapy ( p = .975 and p = .671). In the analysis of survival in patients treated by a combined approach (surgery + radiochemotherapy), a significant difference in favor of patients evaluated by 18F-FDG PET/CT was found ( p = .05 and p = .027). Conclusions Addition of 18F-FDG PET/CT in patients treated by surgery and conformal radiochemotherapy improves outcome. This may be due to the more comprehensive topographic orientation of the primary tumor for the surgeon. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background. Cystic lymph node metastasis (CLNM) is commonly found in human papillomavirus (HPV)- associated tonsillar squamous cell carcinoma (SCC). The aim of this study was to compare the accuracy in detecting cystic lymph node metastasis from tonsillar SCC between contrast-enhanced CT, 18F- fluorodeoxyglucose-positron emission tomography (FDG-PET), non-enhanced 18F-FDG-PET/CT, and contrast-enhanced 18F-FDG-PET/CT. Methods. Thirty-four patients with a tonsillar SCC undergoing a pretreatment contrast-enhanced 18F-FDG-PET/CT followed by a neck dissection as a standard of reference were included. The contrast-enhanced CT part, the 18F-FDG-PET part, the non-enhanced 18F-FDG-PET/CT part, and the contrast- enhanced 18F-FDG-PET/CT were assessed separately for correct N classification and the differentiation of N0 versus N+. Results. Contrast-enhanced 18F-FDG-PET/CT, non-enhanced 18F-FDG-PET/CT, and contrast-enhanced CT are equally accurate for correct neck staging. Regarding pN0 versus pN+, contrastenhanced CT and contrast-enhanced 18F-FDG-PET/CT are superior to non-enhanced 18F-FDG-PET/CT (p = .017). Conclusion. Contrast-enhanced CT and contrast-enhanced 18F-FDG-PET/CT perform equally and better than non-enhanced 18F-FDG-PET/CT in detecting CLNM in tonsillar SCC. Therefore, in patients scheduled for 18F-FDG-PET/CT, we strongly suggest performing a contrast-enhanced 18F-FDGPET/ CT, which is not routine in most centers. [ABSTRACT FROM AUTHOR]

Adequate staging and treatment of the neck in squamous cell carcinoma of the oral cavity and oropharynx (OSCC) is of paramount importance. Elective neck dissection (END) of the clinical N0-neck is widely advocated as neck treatment. With regard to the prevalence of 20-40% of occult neck metastases found in the ND specimens, the majority of patients undergo surgery of the lymphatic drainage basin without therapeutic benefit. Sentinel node biopsy (SNB) has been shown to be a safe, reliable and accurate alternative treatment modality for selected patients. Using this technique, lymphatic mapping is crucial. Previous reports suggested a benefit of single photon emission computed tomography with CT (SPECT/CT) over dynamic planar lymphoscintigraphy (LS) alone. SPECT/CT allows the surgeon for better topographical orientation and delineation of sentinel lymph nodes (SLN's) against surrounding structures. Additionally, SPECT/CT has the potential to detect more SLN's which might harbour occult disease, than LS. SPECT/CT is recommended to be used routinely, although SPECT/CT is not indispensable for successful SNB. [ABSTRACT FROM AUTHOR]

F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET)/CT imaging of squamous cell carcinoma of the head and neck (HNSCC) renders the possibility to study metabolic tumor activity by measuring FDG-uptake expressed as maximum standardized uptake value (SUV). A correlation between SUV and several factors including T-classification, histological tumor differentiation or different anatomic subsites is of potential interest in HNSCC. The aim of this study was to evaluate how metabolic tumor activity derived from FDG-PET correlates with prognostic clinical and pathological parameters including these factors. 262 patients with HNSCC undergoing PET/CT for initial staging were assessed separately for a potential correlation between SUV and T-classification, histological grading, and anatomical subsites of the primary tumor. Nonparametric testing showed a significant correlation between SUV and T-classification ( P < 0.001). On the contrary, no statistically significant correlation was found between SUV and histological tumor grading. Furthermore, no statistical significant correlation between the different anatomical subsites and SUV were found. There was no significant correlation of SUV and tumor grading after adjustment for T-stage and anatomical localization of the tumor, neither. Conclusion: Metabolic tumor activity correlates with T-stage of HNSCC. However, histological tumor grading does not correlate with SUV. The role of primary tumor SUV as a predictor of outcome or survival remains unclear. Clinicians should therefore exercise caution in attributing any clinical importance to SUV obtained from a single PET/CT exam. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Using a retrospective approach, the aim of this study was to confirm the previously described value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with primary extranodal lymphoma of the head and neck region. Additionally, the clinical significance of the semiquantitative analysis of the standardized uptake value (SUV), its predictive role in the follow-up setting, and its value in detection of synchronous primaries were studied. Study Design: Retrospective chart review. Methods: Twenty-six patients with a primary extranodal head and neck lymphoma (22 diffuse large B-cell lymphoma, one Hodgkin's lymphoma, three malignant T-cell lymphomas) were included. We retrospectively evaluated the clinical outcomes according to the maximum standardized uptake values of the primary lesion (SUVmax) and whether a positron emission tomography/computed tomography (PET/CT) was performed or not in the follow-up studies. The median SUVmax was chosen as the cutoff value. The patients were then grouped as those with either low or high SUVmax, respective to the cutoff value. Event-free survival and cumulative survival were endpoints of interest. Results: Nineteen patients (73%) were above the age of 60 years; the median age was 70 years (range, 28–87 years). Most primary sites were in the Waldeyer's ring (15 patients, 60%), whereas in four patients (27%) only the palatine tonsil was affected. The SUVmax ranged from 5.8 to 33.9. In one patient, relevant fluorodeoxyglucose (FDG) uptake within the intestine revealed a cecal adenocarcinoma as a secondary primary. Twenty of the 25 clinically followed patients (80%) achieved complete remission after treatment. Patients with high SUVmax showed favorable survival (log-rank test, P = .044). A tendency for longer survival within the group with follow-up PET/CT studies could be noted but with no significant statistical difference (P = .349). Conclusions: 18F-FDG-PET/CT imaging is a potent primary staging tool. It also has application as an instrument for evaluation of follow-up and response to therapy in patients suffering from primary extranodal lymphoma and for detection of secondary malignancies. Furthermore, 18F-FDG uptake by the primary lesion may be related to better survival. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Background. This study assesses the additional value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/CT (18F-FDG-PET/CT) with respect to synchronous primaries in patients undergoing panendoscopy for staging of head and neck squamous cell carcinoma. Methods. In all, 311 patients underwent both modalities. Cytology, histology, and/or clinical/imaging follow-up served as reference standard. Results. The prevalence of second primary tumors detected by panendoscopy was 4.5%, compared with 6.1% detected by 18F-FDG-PET/CT. The sensitivity for panendoscopy was 74%, the specificity was 99.7%, the positive predictive value (PPV) was 93%, and the negative predictive value (NPV) was 98%. The sensitivity for 18F-FDG-PET/CT was 100%, the specificity was 95.7%, the PPV was 59%, and the NPV was 100%. Conclusions. 18F-FDG-PET/CT is superior to panendoscopy. With a negative 18F-FDG-PET/CT, the extent of endoscopy can be reduced to the area of the primary tumor. Due to the costs, 18F-FDG-PET/CT is recommended only in advanced disease to assess potential distant disease. In early-stage cancer, panendoscopy is accurate enough to rule out secondary tumors. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [ABSTRACT FROM AUTHOR]

A correction to the article "Value of Preoperative Mandibular Plating in Reconstruction of the Mandible" by Dr. Eitan Prisman, Dr. Stephan K. Haerle and Dr. Jonathan C. Irish is presented.

Epstein-Barr virus (EBV) uses nasal mucosa-associated lymphoid tissue (NALT) as a portal of entry to establish life-long persistence in memory B cells. We previously showed that naïve and memory B cells from NALT are equally susceptible to EBV infection. Here we show that memory B cells from NALT are significantly more susceptible to EBV infection than those from remote lymphatic organs. We identify β1 integrin, which is expressed the most by naïve B cells of distinct lymphoid origin and by memory B cells from NALT, as a mediator of increased susceptibility to infection by EBV. Furthermore, we show that BMRF-2-β1 integrin interaction and the downstream signal transduction pathway are critical for postbinding events. An increase of β1 integrin expression in peripheral blood memory B cells provoked by CD40 stimulation plus B-cell receptor cross-linking increased the susceptibility of non-NALT memory B cells to EBV infection. Thus, EBV seems to utilize the increased activation status of memory B cells residing in the NALT to establish and ensure persistence. [ABSTRACT FROM AUTHOR]

Objective: Follow-up of patients with oral cavity squamous cell carcinoma (OCSCC) after tumor resection and reconstruction with tissue transfer is challenging. We compared contrast-enhanced computed tomography (ceCT), (18) F-fluorodeoxyglucose-positron emission tomography combined with noncontrast enhanced CT ((18) F-FDG-PET/CT), and (18) F-FDG-PET combined with ceCT ((18) F-FDG-PET/ceCT) to determine the accuracy for detection of residual/recurrent disease after flap reconstruction for OCSCC., Study Design and Methods: Two readers (R1, R2) retrospectively reviewed a total of 27 (18) F-FDG-PET/ceCT scans in patients after resection of stage II to IV OCSCC. They recorded the presence of local persistence/recurrence (LR), lymph node metastasis, or distant metastasis independently for ceCT, (18) F-FDG-PET/CT, and (18) F-FDG-PET/ceCT. Histological workup, imaging follow-up, or clinical follow-up served as the standard of reference. Maximum standardized uptake value (SUVmax) was evaluated to discriminate between physiological uptake and LR., Results: The highest accuracy to detect LR was achieved with (18) F-FDG-PET/ceCT, with a sensitivity/specificity of 88%/89% and 88%/79% for R1 and R2, respectively, as compared to ceCT with 75%/79% for R1 and 88%/68% for R2 and (18) F-FDG-PET/CT with 88%/58% for both R1 and R2. Receiver-operating-characteristic analysis determined a cutoff value for SUVmax of 7.2, yielding a sensitivity and specificity of 75% and 94%, respectively, to distinguish LR from physiological (18) F-FDG uptake., Conclusion: (18) F-FDG-PET/ceCT seems to be the most reliable tool for locoregional surveillance of OCSCC patients after resection and reconstruction., Level of Evidence: 4., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: The aim of this study was to assess the impact of (18) F-fluoro-2-deoxy-D-glucose ((18) F-FDG) PET/CT on survival for patients with head and neck squamous cell carcinoma correlated with a matched patient cohort., Methods: In all, disease in 58 patients was initially staged using (18) F-FDG PET/CT. A case-control analysis was done with 63 patients who disease was staged without (18) F-FDG-PET/CT., Results: Disease-specific survival (DSS) and overall survival (OS) did not show significant differences between both groups. Statistical analysis revealed no difference in DSS and OS between the 2 groups for patients treated by radiochemotherapy (p = .975 and p = .671). In the analysis of survival in patients treated by a combined approach (surgery + radiochemotherapy), a significant difference in favor of patients evaluated by (18) F-FDG PET/CT was found (p = .05 and p = .027)., Conclusions: Addition of (18) F-FDG PET/CT in patients treated by surgery and conformal radiochemotherapy improves outcome. This may be due to the more comprehensive topographic orientation of the primary tumor for the surgeon., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: Cystic lymph node metastasis (CLNM) is commonly found in human papillomavirus (HPV)-associated tonsillar squamous cell carcinoma (SCC). The aim of this study was to compare the accuracy in detecting cystic lymph node metastasis from tonsillar SCC between contrast-enhanced CT, ¹⁸F- fluorodeoxyglucose-positron emission tomography (FDG-PET), non-enhanced ¹⁸F-FDG-PET/CT, and contrast-enhanced ¹⁸F-FDG-PET/CT., Methods: Thirty-four patients with a tonsillar SCC undergoing a pretreatment contrast-enhanced ¹⁸F-FDG-PET/CT followed by a neck dissection as a standard of reference were included. The contrast-enhanced CT part, the ¹⁸F-FDG-PET part, the non-enhanced ¹⁸F-FDG-PET/CT part, and the contrast-enhanced ¹⁸F-FDG-PET/CT were assessed separately for correct N classification and the differentiation of N0 versus N+. RESULTS.: Contrast-enhanced ¹⁸F-FDG-PET/CT, non-enhanced ¹⁸F-FDG-PET/CT, and contrast-enhanced CT are equally accurate for correct neck staging. Regarding pN0 versus pN+, contrast-enhanced CT and contrast-enhanced ¹⁸F-FDG-PET/CT are superior to non-enhanced ¹⁸F-FDG-PET/CT (p = .017)., Conclusion: Contrast-enhanced CT and contrast-enhanced ¹⁸F-FDG-PET/CT perform equally and better than non-enhanced ¹⁸F-FDG-PET/CT in detecting CLNM in tonsillar SCC. Therefore, in patients scheduled for ¹⁸F-FDG-PET/CT, we strongly suggest performing a contrast-enhanced ¹⁸F-FDG-PET/CT, which is not routine in most centers., (Copyright © 2010 Wiley Periodicals, Inc.)

Background: This study assesses the additional value of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/CT ((18)F-FDG-PET/CT) with respect to synchronous primaries in patients undergoing panendoscopy for staging of head and neck squamous cell carcinoma., Methods: In all, 311 patients underwent both modalities. Cytology, histology, and/or clinical/imaging follow-up served as reference standard., Results: The prevalence of second primary tumors detected by panendoscopy was 4.5%, compared with 6.1% detected by (18)F-FDG-PET/CT. The sensitivity for panendoscopy was 74%, the specificity was 99.7%, the positive predictive value (PPV) was 93%, and the negative predictive value (NPV) was 98%. The sensitivity for (18)F-FDG-PET/CT was 100%, the specificity was 95.7%, the PPV was 59%, and the NPV was 100%., Conclusions: (18)F-FDG-PET/CT is superior to panendoscopy. With a negative (18)F-FDG-PET/CT, the extent of endoscopy can be reduced to the area of the primary tumor. Due to the costs, (18)F-FDG-PET/CT is recommended only in advanced disease to assess potential distant disease. In early-stage cancer, panendoscopy is accurate enough to rule out secondary tumors.