Zusammenfassung
Ziel: Ein korrektes Staging von Kopf-Hals-Tumoren ist entscheidend für die Prognose der Patienten und das weitere therapeutische Vorgehen. Ziel der vorliegenden Studie war es, die Wertigkeit der FDG-PET bezüglich präoperativer Primärdiagnostik, zervikalem Lymphknoten-Staging, Rezidivdiagnostik und Primariussuche bei zervikalen Lymphknotenmetastasen zu überprüfen, die Ergebnisse mit der morphologischen Bildgebung (CT/MRT) zu vergleichen und beide Verfahren mit der Histopathologie zu korrelieren. Patienten/Methodik: 115 Patienten wurden mittels FDG-PET (ECAT EXACT HR+) und CT bzw. MRT untersucht (72 × Primärdiagnostik, 37 × Rezidivdiagnostik und 6 × Primariussuche). Die Befunde wurden mit den Ergebnissen der Histopathologie bezüglich Primär- bzw. Rezidivtumor und Lymphknotenstatus korreliert. Ergebnisse: In der Primärdiagnostik ergab sich für den Nachweis des Primarius eine Sensitivität und Spezifität von 85 % bzw. 100 % für die PET und 88 % bzw. 75 % für CT/MRT. Die Treffsicherheit lag bei 86 % für die PET und 87 % für CT/MRT. Für das primäre Lymphknotenstaging berechnete sich die Sensitivität und Spezifität zu 71 % bzw. 86 % für die PET und zu 74 % bzw. 57 % für CT/MRT. Die Treffsicherheit lag bei 77 % für die PET bzw. 68 % für die morphologische Bildgebung. In 23 Fällen lagen pT1-Tumoren mit Durchmessern < 12 mm vor, welche dem Nachweis durch CT/MRT in 8 Fällen bzw. durch PET in 10 Fällen entgingen. Bezüglich der Rezidivdiagnostik (n = 37) ergaben sich sowohl für die Sensitivität (83 %), die Spezifität (76 %) als auch die Treffsicherheit (78 %) höhere Werte für die PET im Vergleich zu CT/MRT (Sensitivität: 67 %; Spezifität: 52 %; Treffsicherheit: 57 %). Bei 4/6 Patienten mit CUP-Syndrom konnte ein Primarius anhand der Bildgebung gefunden werden (3/4 mittels PET, 2/4 mittels CT/MRT), bei 2/6 Patienten konnte auch im weiteren klinischen Verlauf kein Primärtumor nachgewiesen werden. Schlussfolgerung: Während die FDG-PET in der Primärtumordiagnostik nur einen marginalen diagnostischen Zugewinn zur morphologischen Bildgebung aufweist, zeigt sich hinsichtlich des Lymphknoten-Stagings bei gleicher Sensitivität eine höhere Spezifität. In der Diagnostik des Lokalrezidivs und in der Primariussuche bei CUP-Syndrom scheint die PET der CT/MRT überlegen.
Abstract
Aim: Correct staging of head and neck cancer is important for the patient's prognosis and further therapeutic strategies. Aim of the present study was to investigate the diagnostic value of FDG-PET regarding the pre-surgical diagnosis of primary tumor and cervical lymph node metastases, the diagnosis of tumour recurrence, and the localisation of unknown primary, further to compare the results to those of morphological imaging modalities (CT/MRI) and to correlate the results of both methods with histopathological findings. Patients/Methods: 115 patients (pts) (72 × primary diagnosis, 37 × recurrence, and 6 × unknown primary) underwent FDG-PET (ECAT EXACT HR+) and CT or MRI. Results were correlated with histopathological findings in terms of detection of primary and recurrent tumors as well as lymph node metastases. Results: Regarding the pre-surgical diagnosis, sensitivity and specificity for identifying primary tumors were 85 % and 100 % for PET and 88 % and 75 % for CT/MRI, respectively. Accuracy was 86 % for PET and 87 % for CT/MRI. Sensitivity and specificity for detecting primary lymph node envolvement were 71 %/86 % for PET and 74 %/57 % for CT/MRI, resulting in an accuracy of 77 % with PET and 68 % with morphological imaging. In 23 pts histopathology revealed pT1 stages with tumor diameters < 12 mm. In 8 pts CT/MRI and in 10 pts PET failed to identify these small primary lesions. Detecting tumor recurrence (n = 37) PET showed a higher sensitivity (83 %), specificity (76 %) and accuracy (78 %) compared to CT/MRI (sensitivity: 67 %; specificity: 52 %; accuracy: 57 %). In 4/6 pts with unknown primary, imaging was able to identify a primary lesion (3/4 in FDG-PET, 2/4 in CT/MRI), in 2/6 patients even in the follow-up no primary tumor was found. Conclusions: FDG-PET provides only minor additional information to morphological imaging concerning diagnosis of primary tumors. At a similar level of sensitivity, however, it seems to be more specific regarding the lymph node involvement. PET seems to be superior to CT/MRI in detecting tumor recurrence as well as occult primary tumors in pts with known cervical lymph node metastases.
Schlüsselwörter
HNO-Tumoren - FDG-PET - CT - MRT - CUP
Key words
Head and neck cancer - FDG-PET - CT - MRI - Cancer of unknown primary
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Dr. med. Gabriele Pöpperl
Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München, Klinikum Großhadern
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