Positron-Emission Tomography for Surveillance of Head and Neck Cancer


  • A grant from the Stanford University Medical Scientist Scholars Program helped to fund this study.

    William Ryan performed the data collection at Stanford University Medical Center, Stanford, CA, and the Palo Alto Veterans Affairs Medical Center, Palo Alto, CA, from August 2003 to May of 2004. Ryan performed the data analysis and manuscript composition at Stanford University Medical Center, Stanford, CA, under the supervision of Fee, Le, and Pinto from March to July 2004. Ryan presented this study at the 6th International Conference on Head and Neck Cancer in Washington, DC, on August 9, 2004 where it won the Best Paper by a Medical Student Award.


Objectives/Hypothesis: To determine the diagnostic accuracy and the ideal timing of 18fluoro-fluorodeoxyglucose positron-emission tomography (PET) in the posttreatment surveillance of head and neck mucosal squamous cell carcinoma (HNSCC).

Study Design: Retrospective chart review.

Methods: Our sample includes 103 adult patients with 118 posttreatment PET scans who had undergone treatment for HNSCC. We correlated PET results with surgical pathology and clinical outcome in the subsequent 6 months.

Results: For the detection of locoregional persistent or recurrent HNSCC, PET scans had a sensitivity of 82%, specificity of 92%, positive predictive value (PPV) of 64%, negative predictive value (NPV) of 97%, and overall accuracy of 90%. For the detection of distant metastases, PET scans had a sensitivity of 89%, specificity of 97%, PPV of 85%, NPV of 98%, and overall accuracy of 96%. PET scans of the head and neck region performed greater than 1 month after the completion of radiation compared with scans performed within 1 month had a significantly higher sensitivity of 95% versus 55% (P < .01) and NPV of 99% versus 90% (P < .01).

Conclusion: PET is effective in detecting distant metastases in the posttreatment surveillance for HNSCC patients. A negative PET is highly reliable for all sites. However, a positive PET in the head and neck region is unreliable because of a high false-positivity rate. PET of the head and neck region has a statistically significant risk of a false-negative reading when performed within 1 month of radiation.