Multicenter Trial of [18F]fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging of Head and Neck Cancer and Negative Predictive Value and Surgical Impact in the N0 Neck: Results From ACRIN 6685.

Abstract

PURPOSE:

The objective of this study was to determine the negative predictive value (NPV) of positron emission tomography (PET)/computed tomography (CT) for the clinically N0 neck on the basis of neck dissection.

METHODS:

Participants with newly diagnosed, first-time, head and neck squamous cell carcinoma (HNSCC) and at least one clinically N0 neck side for which dissection was planned were included. A total of 287 participants were prospectively enrolled from 23 American College of Radiology Imaging Network-qualified institutions. PET/CT was compared with findings at neck dissection.

RESULTS:

PET/CT scans and pathology findings were available for 270 N0 neck sides from 212 participants. For visual assessment, the NPV specific to the clinical-N0 sides was 0.868 (95% CI, 0.803 to 0.925). For dichotomized maximum standardized uptake value, the NPVs specific to the nodal basins were 0.940 (95% CI, 0.928 to 0.952) and 0.937 (95% CI, 0.925 to 0.949) at prespecified cutoffs of 2.5 and 3.5, respectively. The optimal cutoff maximum standardized uptake value was determined to be 1.8, with an NPV of 0.942 (95% CI, 0.930 to 0.953). The PET/CT-informed surgical treatment plan was changed in 51 of 237 participants (22%) compared with the PET/CT-blinded surgical plan. In 34 participants (14%), this led to planned dissection of additional nodal levels. In 12 participants (5%), this led to fewer planned dissected nodal levels. Negative PET/CT scans in N0 necks was true negative in 87% and false negative in 13%.

CONCLUSION:

[18F]fluorodeoxyglucose-PET/CT has high NPV for the N0 neck in T2 to T4 HNSCC. The surgical treatment plans on the basis of PET/CT findings may be changed in approximately 22% of this group. These findings suggest that [18F]fluorodeoxyglucose-PET/CT may assist the clinician in deciding on the best therapy for the clinically N0 neck in HNSCC. Well-designed clinical trials should be performed to test the outcome of omitting neck dissection by using PET/CT.

• Authors: Val J Lowe, Fenghai Duan, Rathan M Subramaniam, JoRean D Sicks, Justin Romanoff, Twyla Bartel, Jian Q Michael Yu, Brian Nussenbaum, Jeremy Richmon, Charles D Arnold, David Cognetti, Brendan C Stack Jr
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 37 Issue 20 Pg. 1704-1712 (07 10 2019) ISSN: 1527-7755 [Electronic] United States
• PMID: 30768363 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Chemical References

• Fluorodeoxyglucose F18

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell (diagnostic imaging)
• Female
• Fluorodeoxyglucose F18
• Head and Neck Neoplasms (diagnostic imaging)
• Humans
• Male
• Middle Aged
• Neck (diagnostic imaging)
• Neoplasm Staging (methods)
• Positron Emission Tomography Computed Tomography
• Predictive Value of Tests
• Prospective Studies
• Radiology (standards)
• Treatment Outcome
• Young Adult