Screening for distant metastases in head and neck cancer patients by chest CT or whole body FDG-PET: a prospective multicenter trial

A. Senft, R. de Bree, O. Hoekstra, D. Kuik, R. Golding, W. Oyen, J. Pruim, F. van den Hoogen, J. Roodenburg and C. Leemans

Department of Otolaryngology/Head and Neck Surgery, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
May, 2008



The aim of the study was to define the added value of whole body FDG-PET in screening for distant metastases in patients with head and neck squamous cell carcinoma and risk factors.In a multi-center prospective study between 1998 and 2003, 145 consecutive HNSCC patients with risk factors for distant metastases underwent chest CT and whole body FDG-PET for screening of distant metastases. The data of 92 evaluable patients who developed distant metastases or who had a follow-up of at least 12 months were analyzed. Besides their performance in clinical practice, the operational characteristics of PET and CT using ROC analyses were investigated.Pretreatment screening identified distant metastases in 19 patients (21\%). FDG-PET had a higher sensitivity (53\% vs. 37\%) and positive predictive value (80\% vs. 75\%) than CT. The combination of CT and FDG-PET had the highest sensitivity (63\%). The ROC analyses of the five point ordinal scales revealed that the "area under the curve" (AUC) of FDG-PET was significantly higher as compared to CT.In HNSCC patients with risk factors, pretreatment screening for distant metastases by chest CT is improved by FDG-PET.