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Nuklearmedizin 2002; 41(02): 108-113
DOI: 10.1055/s-0038-1625642
Originalarbeiten – Original Articles
Schattauer GmbH

Lymph node staging in extracranial head and neck cancer with FDG PET – appropriate uptake period and size-dependence of the results

Lymphknotenstaging bei extrakraniellen Kopf-Hals-Malignomen mit FDG PET – optimale Uptake-Zeit und Größenabhängigkeit der Ergebnisse
I. Brink
1   Abteilung Nuklearmedizin (Direktor: Prof. Dr. Dr. Dr. h. c. E. Moser), der Universitätsklinik Freiburg, Deutschland
,
Th. Klenzner
2   Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde (Direktor: Prof. Dr. Dr. h. c. R. Laszig), der Universitätsklinik Freiburg, Deutschland
,
Th. Krause
1   Abteilung Nuklearmedizin (Direktor: Prof. Dr. Dr. Dr. h. c. E. Moser), der Universitätsklinik Freiburg, Deutschland
,
M. Mix
1   Abteilung Nuklearmedizin (Direktor: Prof. Dr. Dr. Dr. h. c. E. Moser), der Universitätsklinik Freiburg, Deutschland
,
U. H. Ross
2   Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde (Direktor: Prof. Dr. Dr. h. c. R. Laszig), der Universitätsklinik Freiburg, Deutschland
,
E. Moser
1   Abteilung Nuklearmedizin (Direktor: Prof. Dr. Dr. Dr. h. c. E. Moser), der Universitätsklinik Freiburg, Deutschland
,
E. U. Nitzsche
1   Abteilung Nuklearmedizin (Direktor: Prof. Dr. Dr. Dr. h. c. E. Moser), der Universitätsklinik Freiburg, Deutschland
› Author Affiliations
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Publication History

Received: 24 October 2001

in revised form: 27 October 2001

Publication Date:
10 January 2018 (online)

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Summary

Aim: Identification of a rationale for the appropriate uptake period for static clinical extracranial head and neck PET imaging and evaluation of the diagnostic accuracy of such an optimized FDG PET approach for lymph node staging in the head and neck region. Methods: In a subset of 5 patients, kinetic tumour studies were performed in order to identify the cellular activity plateau phase of FDG accumulation for head and neck cancer. Seventy-eight consecutive patients (11 women, 67 men; mean age ± SD: 55 ± 11 years; range, 36-78 years), presenting with histologically proven squamous cell carcinoma and sonographically detected lymph nodes in 86 neck sides, underwent clinically indicated FDG PET imaging. PET results were compared to those derived from histological examinations and follow-up imaging results after 6 months in order to calculate sensitivity and specificity for lymph node staging. Results: FDG kinetics in head and neck cancer indicate that the cellular activity plateau of FDG accumulation is reached after an uptake period of 90 min. Using this protocol metastatic involvement of neck sides with lymph nodes less than 1 cm in diameter was correctly identified with a sensitivity of 71.4% and a specificity of 92.3%. Sensitivity increased with the lymph node diameter (1.1-1.5 cm 83.3%, 1.6-2.0 cm 100%, > 2 cm 88.9%). Conclusion: The appropriate uptake period for static clinical extracranial head and neck PET imaging that allows measurements in the activity plateau phase is about 90 min. FDG PET may add some significant information regarding metastatic spread into regional lymph nodes.

Zusammenfassung

Ziel: Ermittlung der optimalen Uptake-Zeit für statische onkologische PET-Untersuchungen mit 18F-FDG im Kopf-Hals-Bereich und der diagnostischen Genauigkeit im Lymphknotenstaging dieser Region unter Nutzung dieses optimierten Untersuchungsprotokolls. Methoden: Kinetische Studien zur Identifikation der intrazellulären Aktivitätsplateauphase wurden bei 5 Patienten mit primärem Plattenepithelkarzinom der Kopf-Hals-Region durchgeführt. 78 konsekutive Patienten (11 Frauen, 67 Männer, Alter 36-78 Jahre, ± SD: 55 ± 11 Jahre) mit histologisch gesichertem Plattenepithelkarzinom und sonographisch nachweisbaren Lymphknoten in insgesamt 86 Halsseiten wurden mittels statischer FDG PET untersucht. Die PET-Ergebnisse wurden mit histologischen Befunden und den Ergebnissen klinischer Verlaufskontrollen über wenigstens 6 Monate verglichen. Ergebnisse: In den kinetischen Studien wurde ca. 90 min nach FDG-Injektion ein intratumorales Aktivitäts-plateau erreicht. Unter Anwendung dieser Uptake-Zeit wurden Lymphknotenmetastasen in Halsseiten mit Lymphknoten < 1 cm im Durchmesser mit einer Sensitivität von 71,4% und einer Spezifität von 92,3% nachgewiesen. Die Sensitivität stieg mit dem Lymphknotendurchmesser (1,1-1,5 cm 83,3%, 1,6-2,0 cm 100%, > 2 cm 88,9%). Schlussfolgerungen: Für statische onkologische FDG-PET-Aufnahmen im Kopf-Hals-Bereich ist eine Uptake-Zeit von 90 min, die Messungen in einer Aktivitätsplateauphase erlaubt, empfehlenswert. FDG PET erweist sich als ein hilfreiches Instrument im regionären Lymphknotenstaging dieser Körperregion.

Keywords

Head and neck cancer - lymph node staging - 18F-FDG PET - metastases

Schlüsselwörter

Kopf-Hals-Tumoren - Lymphknotenstaging - 18F-FDG-PET - Metastasen
 

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