High energy probe for detecting lymph node metastases with ¹⁸F-FDG in patients with head and neck cancer

Summary

Aim of this study was to validate a newly developed high energy probe (positron emission probe, PEP) optimised for localising PET tracers in vivo. Patients and methods: Physical investigations included determination of full width at half maximum (FWHM) values at a distance of 1 cm and angular resolution using different point sources. Values obtained with the new probe were compared to those of a conventional gamma probe (CGP). Additionally, PET studies were performed in 36 patients (6 women, 30 men) with proven head and neck cancer and suspected lymph node metastases (Axis, Marconi/Philips) after administering 250–320 MBq ¹⁸F-FDG. Subsequent to PET investigations ¹⁸F-FDG uptake in cervical regions was measured using the PEP. PEP investigations were carried out bilaterally in 5 lymph node (LN) levels (Robbins’ classification of the neck). Results of probe studies were correlated with visual and semiquantitative PET evaluations, US and histological findings. Results: FWHM of the new probe was 7 mm (CGP 22 mm) at 662 keV (¹³⁷Cs) and angular resolution resulted in 8° (CGP 60°). In 29 out of 36 patients LN metastases were suspected due to ultrasound investigations. After neck dissection, histology confirmed LN metastases in 21 patients. Sensitivity (sens.) of US amounted to 95% and specificity to 40%. In 18/21 patients LN metastases were detected by PET (sens. 86%). PET scans failed to diagnose the LN status correctly in 6/36 patients (accuracy 83%). Employing the PEP probe in 20/21 patients LN metastases were identified (sens. 95%), and LN status was determined accurately in 29/36 patients (accuracy 81%). Tumour/ background ratios of PEP measurement and results of semiquantitative PET analyses were comparable. Conclusions: PEP measurement is a promising method for preoperative planning of the extent of neck dissection in patients with head and neck cancer and further for radioguided localising PET tracer accumulation during surgery.

Zusammenfassung

Ziel dieser Arbeit war es, eine neu entwickelte Hochenergie- Sonde (Positronenemissionssonde, PES) die für die Lokalisation von PET-Tracern optimiert wurde, zu validieren. Patienten und Methoden: Die physikalischen Untersuchungen umfassten die Bestimmung der Ortsauflösung (FWHM) sowie der Winkelauflösung. Die ermittelten Werte wurde mit denen einer konventionellen Gammasonde (KGS) verglichen. Zusätzlich wurde bei 36 Patienten mit gesicherten Kopf-Hals-Tumoren und fraglicher Lymphknoten( LK)-Metastasierung eine PET-Untersuchung (Axis, Marconi/Philips) mit 250–350 MBq ¹⁸F-FDG durchgeführt. Die Ermittlung des ¹⁸F-FDG-Uptake in den zervikalen Regionen mit der PES erfolgte im Anschluss an die PETUntersuchungen, bilateral in jeweils 5 LK-Level (Robbins’ Klassifikation des Halses). Die Resultate der Sondenmessungen wurden mit den visuellen und semiquantitativen Auswertungen der PET-Untersuchungen sowie mit den Ergebnissen der Ultraschalluntersuchung (US) und der Histologie verglichen. Ergebnisse: Die FWHM der neuen Sonde betrug 7 mm (KGS 22 mm) für die 662 keV (¹³⁷Cs) Quelle, die Winkelauflösung betrug 8° (KGS 60°). Bei 29 der 36 Patienten wurden aufgrund der US LK-Metastasen vermutet. Nach der Neck-Dissektion wurde dies bei 21 Patienten bestätigt. Die Sensitivität (Sens.) der US betrug 95%, die Spezifität 40%. Die PET konnte bei 18/21 die LK-Metastasen nachweisen (Sens. 86%). Bei 6/36 Patienten wurde mittels PET der LK-Status nicht korrekt ermittelt (Richtigkeit 83%). Durch Einsatz der PES konnten bei 20/21 Patienten die LK-Metastasen detektiert werden (Sens. 95%), der LK-Status wurde bei 29/36 Patienten korrekt beurteilt (Richtigkeit 81%). Die Tumor/Background- Verhältnisse der PES-Messungen und der semiquantitativen PET-Auswertung waren vergleichbar. Schlussfolgerungen: Die PES-Messung ist eine vielversprechende Methode für die präoperativen Planung der Neck-Dissektion bei Patienten mit Kopf-Hals-Tumoren und zukünftig für die radioaktivitätsgeführte intraoperative Lokalisation von PET-Tracern.

Keywords

High energy gamma probe - ¹⁸F-FDG - PET - head and neck cancer

Schlüsselwörter

Hochenergiesonde - ¹⁸F-FDG - PET - Kopf-Hals-Tumore

• References

• 1 Adams S, Baum RP, Stuckensen T. et al. 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 1998; 25: 1255-60.
• 2 Alex JC, Sasaki CT, Krag DN. et al. Sentinel lymph node radiolocalization in head and neck squamous cell carcinoma. Laryngoscope 2000; 110: 198-203.
• 3 Bärwolff H, Göbel T, Hug O. et al. Vorrichtung und Verfahren zur Bestimmung der Position eines Positronenemitters in einem Material. Patent no. DE 10112297 A1.
• 4 Botsch H, Beringer K, Petersen J. et al. Singlephoton emission tomography studies of rubidium- 81 in the detection of ischaemic heart disease, using a stress-reinjection protocol. Eur J Nucl Med 1994; 21: 407-14.
• 5 Brink I, Klenzner T, Krause T. et al. Lymph node staging in extracranial head and neck cancer with FDG PET--appropriate uptake period and size-dependence of the results. Nuklearmedizin 2002; 41: 108-13.
• 6 Brown AE, Langdon JD. Management of oral cancer. Ann R Coll Surg Engl 1995; 77: 404-8.
• 7 Buell U, Wieres FJ, Schneider W. et al. ¹⁸FDG-PET in 733 consecutive patients with or without sideby- side CT evaluation: analysis of 921 lesions. Nuklearmedizin 2004; 43: 210-6.
• 8 Essner R, Daghighian F, Giuliano AE. Advances in FDG PET probes in surgical oncology. Cancer J 2002; 8: 100-8.
• 9 Essner R, Hsueh EC, Haigh PI. et al. Application of an ¹⁸F fluorodeoxyglucose-sensitive probe for the intraoperative detection of malignancy. J Surg Res 2001; 96: 120-6.
• 10 Gerl J, Kojouharov I, Ameil F. et al. High energy gamma probe with position sensing capability. Patent no. EP 04011020.7.
• 11 Goerres GW, Haenggeli CA, Allaoua M. et al. Direct comparison of ¹⁸F-FDG PET and ultrasound in the follow-up of patients with squamous cell cancer of the head and neck. Nuklearmedizin 2000; 39: 246-50.
• 12 Gritzmann N, Czembirek H, Hajek P. et al. Sonography in cervical lymph node metastases. Radiologe 1987; 27: 118-22.
• 13 Hickernell TS, Barber HB, Barrett HH. et al. Dualdetector probe for surgical tumor staging. J Nucl Med 1988; 29: 1101-6.
• 14 Hoffman E-J, Tornai M-P, Janecek M. et al. Intraoperative probes and imaging probes. Eur J Nucl Med 1999; 26: 913-35.
• 15 Hyde NC, Prvulovich E, Newman L. et al. New approach to pretreatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography. Oral Oncol 2003; 39: 350-60.
• 16 Kubota R, Yamada S, Kubota K. et al. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992; 33: 1972-80.
• 17 Landoni C, Gianolli L, Lucignani G. et al. Comparison of dual-head coincidence PET versus ring PET in tumor patients. J Nucl Med 1999; 40: 1617-22.
• 18 Meller B, Sahlmann C, Horstmann O. et al. Conventional gamma probe and high energy probe for radioguided dissection of metastases in a patient with recurrent thyroid carcinoma with ^99mTc- MIBI and ¹⁸F-FDG. Nuklearmedizin 2005; 44: N23-5.
• 19 Minn H, Lapela M, Klemi PJ. et al. Prediction of survival with fluorine-18-fluoro-deoxyglucose and PET in head and neck cancer. J Nucl Med 1997; 38: 1907-11.
• 20 Pitre S, Menard L, Ricard M. et al. A hand-held im- aging probe for radio-guided surgery: physical performance and preliminary clinical experience. Eur J Nucl Med Mol Imaging 2003; 30: 339-43.
• 21 Reske SN, Bares R, Büll U. et al. Clinical value of positron emission tomography (PET) in oncologic questions: results of an interdisciplinary consensus conference. Nuklearmedizin 1996; 35: 42-52.
• 22 Robbins KT. Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am 1998; 31: 639-55.
• 23 Schmidt M, Schmalenbach M, Jungehulsing M. et al. ¹⁸F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases. Comparison of qualitative visual and semiquantitative analysis. Nuklearmedizin 2004; 43: 91-101.
• 24 Shoaib T, Soutar DS, MacDonald DG. et al. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer 2001; 91: 2077-83.
• 25 van den Brekel MW, Stel HV. et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 1990; 177: 379-84.
• 26 Van Lingen A, Huijgens PC, Visser FC. et al. Performance characteristics of a 511-keV collimator for imaging positron emitters with a standard gamma-camera. Eur J Nucl Med 1992; 19: 315-21.
• 27 Wengenmair H, Kopp J, Sciuk J. Quality criteria of gamma probes: requirements and future developments. In: Schauer A, Becker W, Reiser MF. et al. (eds). The Sentinel Lymph Node Concept. Berlin, Heidelberg: Springer; 2004: 113-25.
• 28 Wengenmair H, Kopp J, Vogt H. et al. Qualitätskriterien für Meßsonden zur intraoperativen Lokalisation ^99mTc-markierter Lymphknoten. Z Med Phys 1999; 9: 122-8.
• 29 Wengenmair H, Kopp J, Vogt H. et al. Qualitätskriterien und Vergleich von Gammasonden zur Sentinel-Lymphonodektomie. Der Nuklearmediziner 1999; 4: 271-80.
• 30 Woolfenden JM, Barber HB. Radiation detector probes for tumor localization using tumor-seeking radioactive tracers. AJR Am J Roentgenol 1989; 153: 35-9.
• 31 Yamamoto S, Matsumoto K, Sakamoto S. et al. An intra-operative positron probe with background rejection capability for FDG-guided surgery. Ann Nucl Med 2005; 19: 23-8.
• 32 Zervos EE, Desai DC, De Palatis LR. et al. ¹⁸F-labeled fluorodeoxyglucose positron emission tomography- guided surgery for recurrent colorectal cancer: a feasibility study. J Surg Res 2001; 97: 9-13.
• 33 Zimny M, Wildberger JE, Cremerius U. et al. Combined image interpretation of computed tomography and hybrid PET in head and neck cancer. Nuklearmedizin 2002; 41: 14-21.