Limitations of FDG-PET and FDG-PET with computed tomography for detecting synchronous cancer in pharyngeal cancer

Hidenori Suzuki, Yasuhisa Hasegawa, Akihiro Terada, Tetsuya Ogawa, Ikuo Hyodo, Masahiro Suzuki, Tsutomu Nakashima, Tsuneo Tamaki, Masami Nishio
Archives of Otolaryngology—Head & Neck Surgery 2008, 134 (11): 1191-5

OBJECTIVE: To analyze the ability of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and the fusion of FDG-PET with computed tomography (FDG-PET/CT) to detect synchronous upper gastrointestinal tract (UGI) cancer in newly diagnosed pharyngeal squamous cell carcinoma (SCC). Synchronous UGI cancer is a significant problem in treating pharyngeal SCC, particularly for Japanese populations reported to be at high risk. Good results have been reported from the use of FDG-PET and FDG-PET/CT in staging head and neck SCC (HNSCC). An additional advantage is that both techniques are expected to prove useful in detecting synchronous cancer.

DESIGN: Retrospective analysis of medical records.

SETTING: Aichi Cancer Center, Nagoya, Japan.

PATIENTS: Forty-three Japanese patients with pharyngeal SCC were assessed for the ability of FDG-PET and FDG-PET/CT to detect synchronous UGI cancer via a comparison with UGI Lugol chromoendoscopy. The patients had undergone 17 FDG-PET and 26 FDG-PET/CT scans before treatment.

MAIN OUTCOME MEASURE: Sensitivity of FDG-PET and FDG-PET/CT to detect synchronous UGI cancer.

RESULTS: Pathologically, 6 patients with esophageal SCC (14%) and 4 with stomach adenocarcinoma (9%) were diagnosed on the basis of suspect lesions detected by UGI Lugol chromoendoscopy. One patient was found to have stage T2 esophageal cancer by FDG-PET/CT, but no patients had UGI cancer. The sensitivity of detecting T1 UGI cancer by FDG-PET and FDG-PET/CT was 0%.

CONCLUSIONS: The choice of diagnostic technique must be based on the site and histologic characteristics of the synchronous tumor. Although FDG-PET and FDG-PET/CT are still the preferred techniques for staging HNSCC, neither replaces Lugol chromoendoscopy for detecting synchronous UGI cancer in high-risk populations.

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