FDG PET Imaging for Head And Neck Cancer

PET/CT is approved by Medicare for use in identifying the primary lesion, staging, restaging and detecting recurrence in esophageal cancer. Because there are many sources of benign FDG uptake in the head and neck, PET/CT is considerably more accurate than PET-alone in this region.

2004 Head & Neck Cancer Statistics*

  • Estimated New Cases 28.260
  • Estimated New Deaths 7,230

*All cancer statistics obtained from the American Cancer Society’s Cancer Facts and Figures available at www.cancer.org.

Head & Neck Cancer & FDG PET Imaging Statistics**

Table 1: Utility of PET Imaging in Head & Neck Diagnosis (N=193)

  PET CT
Sensitivity 93% 66%
Specificity 70% 56%
Accuracy 87% 58%

Table 2: Utility of PET Imaging in Head & Neck Diagnosis/Staging (N=330)

  PET CT
Sensitivity 88% 69%
Specificity 83% 85%
PPV 76% 88%
NPV 90% 91%
Accuracy 88% 73%

For this patient population there was a 33% change in the way the physician managed the patient’s disease based upon the PET scan.

Table 3: Utility of PET Imaging in Head & Neck Staging (N=468)

  PET CT
Sensitivity 87% 62%
Specificity 89% 73%
PPV 86% N/A
NPV 78% N/A
Accuracy 88% 67%

Table 4: Utility of PET Imaging in Head & Neck Recurrence (N=426)

  PET CT
Sensitivity 93% 54%
Specificity 83% 74%
PPV 73% 67%
NPV 91% 33%
Accuracy 87% 65%

For this patient population there was a 33% change in the way the physician managed the patient’s disease based upon the results of the PET scan.

Table 5: Utility of PET Imaging in Monitoring Head & Neck Cancer (N=128)

  PET CT
Sensitivity 84% 60%
Specificity 95% 39%
PPV 92% N/A
NPV 71% N/A
Accuracy 96% 54%

** Reprinted by permission of the Society of Nuclear Medicine from: Gambhir, Sanjiv S., Czernin, Johannes, Schwimmer, Judy, Silverman, Daniel H.S., Coleman, R. Edward, Phelps, Michael E. “A Tabulated Summary of the FDG PET Literature” J Nucl Med 2001 42: 1-93.

Case Study:
Patient: 71yo male with history of T4 N1 squamous cell carcinoma of the left piriform sinus seven years ago. He was treated with chemo and radiation. He now presents with left ear discomfort and throat pain.There is a new 0.5 cm left base tongue mass. FDG was ordered for staging.

Results: PET/CT of the whole body and did not find occult disease. The patient was sent to surgery