Comparison of positron emission tomography/computed tomography imaging and ultrasound in staging and surveillance of head and neck and thyroid cancer
ABSTRACT Positron emission tomography (PET) combined with cross-sectional computed tomography (CT) is increasingly used for staging and surveillance of cancers in the head and neck region. Ultrasonography (US) is an alternative imaging technique that provides diagnostic information while enabling simultaneous image-guided biopsies. A comparison of these diagnostic modalities in cancer detection is warranted.
All patients with malignant neoplasms in the head and neck region who were evaluated by both PET/CT and US were reviewed. Diagnostic accuracy rates of PET/CT and US were determined according to whether cytologically or histologically confirmed cancer was present in US-guided fine-needle biopsy or surgical specimens.
From October 2004 to December 2007, 42 patients with an ultimately confirmed tissue diagnosis of a head and neck malignancy underwent both neck US and PET/CT. The sensitivity and specificity of US in predicting malignancy in the head and neck was 96.8% and 93.3%, respectively, in those 42 individuals. The positive predictive value (PPV) was 96% and the negative predictive value (NPV) was 93%. In comparison, PET/CT in this group demonstrated a sensitivity of 90.3%, specificity 20%, PPV 70%, and NPV 50%.
PET/CT and US, especially when combined with US-guided fine-needle biopsy, are complementary tools in the detection of cancers of the head and neck. The highly sensitive and specific nature of US, combined with its low cost, low morbidity, availability as an in-office examination, and ability to guide biopsies, warrant consideration of its routine use in the management of head and neck and thyroid cancer patients.
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ABSTRACT: The increasing proportion of human papilloma virus-related oropharynx cancers has led to improved success in the treatment of this disease. However, the current low recurrence rate after treatment of oropharyngeal cancer highlights the continued need for, as well as the challenges of, designing an effective follow-up surveillance program. There are frequently multiple modalities used in the treatment of oropharyngeal cancer, resulting in short- and long-term tissue changes to the head and neck that challenge clinical distinction of recurrence versus treatment-related changes. The oropharynx subsite is characterized by complex anatomy not always accessible to physical exam, making radiologic imaging a potentially useful supplement for effective follow-up assessment. In this manuscript, the literature regarding the type of radiologic imaging modality and the frequency of obtaining imaging studies in the surveillance follow-up after treatment of oropharyngeal cancer is reviewed. While ultrasound and MRI have useful characteristics that deserve further study, PET/CT appears to have the best sensitivity and specificity for imaging surveillance follow-up of head and neck cancers including oropharyngeal cancer. A negative PET/CT is particularly useful as a predictor of prognosis and can guide the clinician as to when to stop obtaining additional imaging studies in the absence of clinical signs of recurrence. However, there is scant evidence that imaging surveillance can improve survival outcomes. Suggestions to guide future imaging surveillance research studies are provided.World Journal of Surgical Oncology 12/2015; 13(1):481. DOI:10.1186/s12957-015-0481-1 · 1.20 Impact Factor
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ABSTRACT: Background: Optical coherence tomography(OCT) allows tissue histologic-like evaluation, but without tissue fixation or staining. We investigated OCT images from tissues obtained at thyroid and parathyroid surgeries to provide a preliminary assessment as to whether these images contain sufficient information for recognition and differentiation of normal neck tissues. Methods: Normal tissues were obtained from patients undergoing surgical treatment. Two new-generations OCT systems including optical frequency domain imaging(OFDI) and µOCT were compared to representative H&E histology. Results: Thyroid, fat, muscle, lymph nodes, and parathyroid tissues were evaluated. Histologic-like microscopic characteristics sufficient for tissue type identification was realized using both systems for all tissue types examined. Conclusions: This pilot study demonstrated that new-generation OCT systems are capable of recognizing and differentiating neck tissues encountered during thyroid and parathyroid surgeries. Further advances in OCT miniaturization and development of sterile intraoperative probe formats may allow OCT to offer an intraoperative "optical biopsy" without fixation, staining or tissue resection. Head Neck, 2013.Head & Neck 11/2013; 36(9). DOI:10.1002/hed.23452 · 3.01 Impact Factor
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ABSTRACT: Background Posttreatment surveillance for the local and regional recurrence of the head and neck squamous cell carcinoma often requires a multimodality techniques that include PET combined with CT, MRI, US.Reports of Practical Oncology and Radiotherapy 09/2011; 16(5):184-188. DOI:10.1016/j.rpor.2011.04.007