Utility of positron-emission tomography/computed tomography imaging in the management of the neck in recurrent laryngeal cancer.

OBJECTIVES/HYPOTHESIS: Patients who develop recurrence of laryngeal cancer after radiotherapy organ preservation protocols are offered salvage laryngectomy, often with bilateral neck dissection. However, there can be multiple complications of neck dissection in the previously irradiated neck, including poor wound healing and increased potential for fistula. Positron-emission tomography/computed tomography (PET/CT) may have the ability to spare some of these patients from the morbidity of unnecessary neck dissections if it can reliably exclude recurrent nodal disease. The purpose of our study was to determine whether preoperative PET/CT could correctly predict the pathologic status of the neck in patients with locally recurrent laryngeal cancer and clinically N0 neck.

STUDY DESIGN: Retrospective review.

METHODS: A review of our head and neck tumor registry revealed 269 patients with recurrence of laryngeal cancer from 1975 to 2010. Out of this pool, we identified 15 patients who had PET/CT scans prior to neck dissections for recurrent laryngeal cancer.

RESULTS: Five patients with pathologically negative neck had accurate PET/CT reads (100% specificity) prior to surgery. Similarly, seven patients who had a PET/CT read positive for cervical disease had pathologically positive nodes (100% positive predictive value). However, three patients with clinically N0 neck who had PET/CT reads that were negative had positive nodal pathology, giving a sensitivity of 70% and a 62.5% negative predictive value.

CONCLUSIONS: We believe that this false negative rate is too high to warrant deferring neck dissection based on PET/CT, and we recommend that patients who are clinically N0 for recurrent laryngeal cancer be offered neck dissection along with salvage laryngectomy.