Skip to main content

Advertisement

Log in

CT, MR, US, 18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck

  • Head and Neck
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The purpose of this retrospective study was to compare the diagnostic value of four different imaging methods—computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT—and their combined use for preoperative detection of cervical nodal metastases in head and neck squamous cell carcinoma (SCC). Sixty-seven patients (58 men and 9 women; mean age, 60.1 years) with head and neck SCCs underwent CT, MR, US, and PET/CT before surgery. First, each study was reviewed separately for the presence of nodal metastases. Then, the value of combined images was assessed based on a confidence rating score for each modality assigned by observers. These results were verified, on a level-by-level basis, with histopathologic findings. Histopathologic examination revealed nodal metastases in 74 of 402 nodal levels. The sensitivity, specificity, and accuracy were 77.0%, 99.4%, and 95.3% for CT and MR; 78.4%, 98.5%, and 94.8% for US; and 81.1%, 98.2%, and 95.0% for PET/CT, respectively. The comparison of these modalities showed no statistically significant difference among them (p > 0.05). The combination of CT, MR, US, and PET/CT improved sensitivity (86.5%), without loss of specificity (99.4%) and accuracy (97.0%), although the difference failed to reach statistical significance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Parker SL, Tong T, Bolden S et al (1996) Cancer statistics 1996. CA Cancer J Clin 46:5–27

    Article  CAS  PubMed  Google Scholar 

  2. Vokes EE, Weichselbaum RR, Lippman SM et al (1993) Head and neck cancer. N Engl J Med 328:184–194

    Article  CAS  PubMed  Google Scholar 

  3. Snow GB, Patel P, Leemans CR, Tiwari R (1992) Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249:187–194

    Article  CAS  PubMed  Google Scholar 

  4. Layland MK, Sessions DG, Lenox J (2005) The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+ . Laryngoscope 115:629–639

    PubMed  Google Scholar 

  5. Adams S, Baum RP, Stuckensen T, Bitter K, Hor G (1998) Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MR imaging, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 25:1255–1260

    Article  CAS  PubMed  Google Scholar 

  6. Braams JW, Pruim J, Freling NJ et al (1995) Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MR imaging. J Nucl Med 36:211–216

    CAS  PubMed  Google Scholar 

  7. Laubenbacher C, Saumweber D, Wagner-Manslau C et al (1995) Comparison of fluorine-18-fluorode-oxyglucose PET, MR imaging and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med 36:1747–1757

    CAS  PubMed  Google Scholar 

  8. Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM (2004) Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 231:65–72

    Article  PubMed  Google Scholar 

  9. Som PM, Curtin HD, Mancuso AA (2000) Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR 174:837–844

    CAS  PubMed  Google Scholar 

  10. Sakai O, Curtin HD, Romo LV, Som PM (2000) Lymph node pathology: benign proliferative, lymphoma, and metastatic disease. Radiol Clin North Am 38:979–998

    Article  CAS  PubMed  Google Scholar 

  11. Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220

    CAS  PubMed  Google Scholar 

  12. Hayashi I, Kawata R, Lee K, Sakurai K, Tsuji Y, Takenaka H (2003) A clinical study of ultrasonography for lymph node metastases in head and neck cancer. Nippon Jibiinkoka Gakkai Kaiho 106:499–506

    PubMed  Google Scholar 

  13. Ariji Y, Kimura Y, Hayashi N et al (1998) Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. AJNR Am J Neuroradiol 19:303–307

    CAS  PubMed  Google Scholar 

  14. Madison MT, Remley KB, Latchaw RE, Mitchell SL (1994) Radiologic diagnosis and staging of head and neck squamous cell carcinoma. Radiol Clin North Am 32:163–181

    CAS  PubMed  Google Scholar 

  15. Castelijns JA, van den Brekel MW (2001) Detection of lymph node metastases in the neck: radiologic criteria. AJNR Am J Neuroradiol 22:3–4

    CAS  PubMed  Google Scholar 

  16. Steinkamp HJ, Hosten N, Richter C, Schedel H, Felix R (1994) Enlarged cervical lymph nodes at helical CT. Radiology 191:795–798

    CAS  PubMed  Google Scholar 

  17. Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130

    CAS  PubMed  Google Scholar 

  18. Som PM (1992) Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR 158:961–969

    CAS  PubMed  Google Scholar 

  19. van den Brekel MW, Stel HV, Castelijns JA et al (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384

    PubMed  Google Scholar 

  20. Snow GB, Patel P, Leemans CR, Tiwari R (1992) Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249:187–194

    Article  CAS  PubMed  Google Scholar 

  21. Don DM, Anzai Y, Lufkin RB et al (1995) Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 105:669–674

    Article  CAS  PubMed  Google Scholar 

  22. Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130

    CAS  PubMed  Google Scholar 

  23. King AD, Tse GM, Ahuja AT et al (2004) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology 230:720–726

    Article  PubMed  Google Scholar 

  24. de Bondt RB, Nelemans PJ, Hofman PA et al (2007) Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 64:266–272

    Article  PubMed  Google Scholar 

  25. Sumi M, Ohki M, Nakamura T (2000) Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR 176:1019–1024

    Google Scholar 

  26. Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220

    CAS  PubMed  Google Scholar 

  27. Yonetsu K, Sumi M, Izumi M, Ohki M, Eida S, Nakamura T (2001) Contribution of Doppler sonography blood flow information to the diagnosis of metastatic cervical nodes in patients with head and neck cancer: assessment in relation to anatomic levels of the neck. AJNR Am J Neuroradiol 22:163–169

    CAS  PubMed  Google Scholar 

  28. Chikui T, Yonetsu K, Nakamura T (2000) Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis. AJNR Am J Neuroradiol 21:561–567

    CAS  PubMed  Google Scholar 

  29. Rege S, Maass A, Chaiken L et al (1994) Use of positron emission tomograpy with fluorodeoxyglucose in patients with extracranial head and neck cancers. Cancer 73:3047–3058

    Article  CAS  PubMed  Google Scholar 

  30. Haberkorn U, Strauss LG, Reisser C et al (1991) Glucose uptake, perfusion and cell proliferation in head and neck tumors: relation of positron emission tomography to flow cytometry. J Nucl Med 32:1548–1555

    CAS  PubMed  Google Scholar 

  31. Jabour BA, Choi Y, Hoh CK et al (1993) Extracranial head and neck: PET imaging with 2-[F-18]fluoro-2-deoxy-glucose and MR imaging correlation. Radiology 186:27–35

    CAS  PubMed  Google Scholar 

  32. Braams JW, Pruim J, Freling NJ et al (1995) Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MRI. J Nucl Med 36:211–216

    CAS  PubMed  Google Scholar 

  33. Kau RJ, Alexiou C, Laubenbacher C, Werner M, Schwaiger M, Arnold W (1999) Lymph node detection of head and neck squamous cell carcinomas by positron emission tomography with fluorodeoxyglucose F18 in a routine clinical setting. Arch Otolaryngol Head Neck Surg 125:1322–1328

    CAS  PubMed  Google Scholar 

  34. Laubenbacher C, Saumweber D, Wagner-Manslau C et al (1995) Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med 36:1747–1757

    CAS  PubMed  Google Scholar 

  35. Murakami R, Uozumi H, Hirai T et al (2007) Impact of FDG-PET/CT imaging on nodal staging for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 68:377–382

    PubMed  Google Scholar 

  36. Gordin A, Golz A, Keidar Z, Daitzchman M, Bar-Shalom R, Israel O (2007) The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care. Otolaryngol Head Neck Surg 137:130–137

    Article  PubMed  Google Scholar 

  37. Jeong HS, Baek CH, Son YI et al (2007) Use of integrated 18F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma. Head Neck 29:203–210

    Article  PubMed  Google Scholar 

  38. Adams S, Baum RP, Stuckensen T, Bitter K, Hör G (1998) Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 25:1255–1260

    Article  CAS  PubMed  Google Scholar 

  39. Stuckensen T, Kovács AF, Adams S, Baum RP (2000) Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 28:319–324

    CAS  PubMed  Google Scholar 

  40. Hannah A, Scott AM, Tochon-Danguy H et al (2002) Evaluation of 18F-fluorodeoxyglucose positron emission tomography and computed tomography with histopathologic correlation in the initial staging of head and neck cancer. Ann Surg 236:208–217

    Article  PubMed  Google Scholar 

  41. Ng SH, Yen TC, Liao CT et al (2005) 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46:1136–1143

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dae Young Yoon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoon, D.Y., Hwang, H.S., Chang, S.K. et al. CT, MR, US, 18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Eur Radiol 19, 634–642 (2009). https://doi.org/10.1007/s00330-008-1192-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-008-1192-6

Keywords

Navigation