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Head & Neck Cancer
Case Study #6
Study Background:
A 62 year old male with history of laryngeal cancer, surgically excised 14 months prior to the PET scan, was imaged to evaluate a 3 cm pulmonary nodule identified on CT and suspicious for malignancy. A 1.5 cm pre-tracheal node and 1.5 cm left basal nodule were also identified and thought to be metastatic foci.
PET Imaging:
Sixty-five minutes after the injection of 555 MBq of 18F-FDG, images of the neck, chest, and upper abdomen were obtained with a GE Advance tomograph (8 minutes emission, 3 minutes transmission data per bed position). Data were reconstructed using an OSEM algorithm and segmented attenuation correction. The PET study demonstrates an intense area of increased uptake corresponding to the nodule seen on CT (image on right, long blue arrow). In addition, there is markedly increased FDG uptake in the region of the left hilum (image on right, long red arrow) suspicious for metastasis, not noted on CT. Finally, there is increased metabolism in two 2 cm left cervical nodes (left and center images, short red arrows) not appreciated in any other diagnostic examination. The PET findings were consistent with recurrent squamous cell carcinoma of the head and neck with loco-regional and distant metastases. Of note, the abnormalities in the left lung base and pre-tracheal node were not metabolically active on the PET scan and were thought to be benign and reactive processes, respectively.
Discussion:
PET is a highly reliable imaging technique for the detection of primary and recurrent tumors of the head and neck. In addition, PET has been shown to play an important role in the determination of cervical node involvement as well as occult metastatic spread, particularly in the region of the mediastinum. Accurate staging of head and neck carcinoma is critical to preoperative planning since patients with distant metastases typically do not benefit from surgery.
Reference:
Hannah A, Scott AM, Tochon-Danguy H, et al. Evaluation of 18 F-fluorodeoxyglucose positron emission tomography and computed tomography with histopathologic correlation in the initial staging of head and neck cancer. Ann Surg Aug 2002, 236:208-17
Teknos TN, Rosenthal EL, Lee D, et al. Positron emission tomography in the evaluation of stage III and IV head and neck cancer. Head Neck Dec 2001, 23:1056-60
Di Martino E, Nowak B, Hassan HA, et al. Diagnosis and staging of head and neck cancer: a comparison of modern imaging modalities (positron emission tomography, computed tomography, color-coded duplex sonography) with panendoscopic and histopathologic findings. Arch Otolaryngol Head Neck Surg Dec 2000, 126:1457-61
Images courtesy of:
St. Vincent Medical Center, Erie PA
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