Role of pretreatment 18FDG-PET/CT in surgical decision-making for head and neck cancers.

BACKGROUND: Despite widespread use, the utility of pretreatment positron emission tomography/computed tomography (PET/CT) remains undefined. In this study, we aim to determine its accuracy in nodal disease.

METHODS: In all, 111 patients managed between 2003 and 2007 were analyzed.

RESULTS: For squamous cell cancers (SCCs) with any increased nodal uptake (mild to high), sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were 75%, 95%, 85%, and 90%. However, if PET was deemed positive for only moderate to high uptake, sensitivity, specificity, PPV, and NPV were 71%, 95%, 85%, and 89%. In patients undergoing elective neck dissection, the accuracy was lower: for any increased uptake, sensitivity, specificity, PPV, and NPV were 66%, 96%, 83%, and 92%, whereas for moderate to high uptake, these were 52%, 97%, 79%, and 89%.

CONCLUSIONS: Despite advances in PET/CT technology, these statistics suggest that PET/CT is not sufficiently accurate to direct superselective neck dissections, or to guide therapeutic decisions in the N0 neck.