A prospective study of PET-FDG imaging for the assessment of head and neck squamous cell carcinoma

The main aim of the study was to evaluate the use of positron emission tomography using fluoro‐deoxyglucose (PET‐FDG) imaging for the detection of squamous cell carcinoma of the head and neck. Fifty‐four consecutive patients with malignancies involving the head and neck were studied prospectively. Thirty‐one patients presented with primary disease and 23 were suspected of recurrent or residual disease. All patients underwent full clinical staging, PET‐FDG scans and anatomical imaging, 37 underwent computed tomography (CT), 13 magnetic resonance (MR) and four had both CT and MR. Clinical assessment, CT/MR, PET‐FDG and histological examination were all evaluated independently of each other. All 31 primary head and neck malignant tumours were detected by PET‐FDG. Based on 16 patients who underwent neck dissections, the sensitivity and specificity of PET‐FDG for detecting nodal disease was 67% and 100% respectively, compared with clinical assessment of 58% and 75% and CT/MR of 67% and 25%. In all 12 patients, PET‐FDG correctly identified the presence or absence of recurrent or residual disease. PET‐FDG staged 13 post‐treatment necks with an accuracy of 100%, as compared to CT/MR which was accurate in 7 of 13 and clinical assessment which was accurate in eight. Three sites of abnormal tracer uptake unrelated to malignancy were recorded as incidental findings (mandibular osteomyelitis, 1; post glossectomy site, 2). PET‐FDG was more accurate than CT/MR for identifying primary and recurrent tumours as well as metastatic lesions in the neck. If these diagnostic properties of PET‐FDG are confirmed in further prospective studies, it could prove a valuable adjunct for the management of head and neck cancer.