ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

What Is the Role of PET-CT in Residual Occult Nodal Disease?

by Pippa Wysong • September 1, 2009

  • Tweet
  • Email
Print-Friendly Version

Among the 14 patients who had positive PET-CT findings but no tumor, it was found that five patients had extensive necrosis, and either a histiocytic response or foreign body giant cell reaction was found in nine patients. Of the eight patients in whom PET-CT and pathology studies were both negative for tumors, three patients were found to have radiation fibrosis, and five had a foreign body reaction with giant cells and cholesterol debris.

You Might Also Like

No related posts.

Explore This Issue
September 2009

Overall, the sensitivity and specificity of PET-CT in predicting occult nodal disease was 60% and 36% respectively, Dr. Gourin said, with a positive predictive value of 30%, and a negative predictive value of 67%. PET-CT performed within three months of treatment did not correlate with pathologic findings.

Researchers also took into account the standard uptake value (SUV) of PET and how this may have related to findings. SUV levels show how active cells are in terms of utilizing the FDG contrast material; however, both nonviable tumor cells and areas where inflammation is occurring show increased SUV, which can increase the false positives from PET imaging when PET-CT is performed too early, she said.

Christine Gourin, MDThe efficacy of PET-CT in predicting residual nodal disease after chemoradiation, and thus the need for posttreatment neck dissection, appears dependent on the timing of imaging after chemoradiation.
-Christine Gourin, MD

Timing of PET-CT Also a Factor

Whether post-treatment neck dissection should be used in HNSCC with advanced disease is controversial because not all patients have residual occult disease. But if surgery is to be performed after chemoradiation, evidence suggests that the safest window is four to 12 weeks after chemoradiation. Unfortunately, this window corresponds to a time when PET-CT has a lower accuracy-studies show that performing the imaging later, at about 12 weeks after inflammation has been reduced and there may be an increase in tumor size, is associated with greater accuracy, she said.

Deferring early post-treatment neck dissection in patients without residual adenopathy in favor of obtaining PET-CT imaging in 12 weeks, or later, following chemoradiation may be a viable approach to help reduce the number of unnecessary neck dissections, Dr. Gourin said.

The regional recurrence rate after planned neck dissection was 6%, which is similar to rates reported for patients with a complete response who are observed with serial negative PET-CT imaging. Overall, our data suggest that not all residual viable tumors in post-treatment neck dissections are viable and that the timing of PET-CT should influence the decision to proceed with neck dissection, not the other way around, she said.

Another Opinion

Another take on the subject came from Cherie Ryoo, MD, a fourth-year resident in otolaryngology-head and neck surgery at Ohio State University, who presented findings from a retrospective study of 243 head and neck cancer patients who had a diagnosis of upper aerodigestive tract squamous cell cancer. Data were collected for patients who were treated from January 2005 to December 2007.

Pages: 1 2 3 | Single Page

Filed Under: Everyday Ethics, Head and Neck Tagged With: COSM, head and neck cancer, HNSCC, neck dissection, patient safety, PET, PET-CTIssue: September 2009

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Is Radiofrequency Ablation a Good Alternative to Surgery for Benign Thyroid Nodules? A Look at Benefits, Risks
    • What Happens to Medical Students Who Don’t Match?
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Complications for When Physicians Change a Maiden Name
    • Smell and Taste Disorder Differences Seen Between Long-Term COVID-19 and non-COVID-19 Patients
    • The Triological Society is Growing in Ethnic and Gender Diversity as Well as Thesis Acceptance
    • No Persistent Postoperative Swallowing Dysfunction Following Pharyngeal Surgery in Patients with Obstructive Sleep Apnea
    • Do the Principles of Adult Learning Maximize Training Efficiency and Efficacy for Pediatric Otolaryngologists?
    • Prolonged Operative Time Associated with Multiple Adverse Outcomes in Endoscopic Sinonasal Surgery

Polls

Do you think that women have made large enough strides in otolaryngology leadership and gender equity?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2023 The Triological Society. All Rights Reserved.
ISSN 1559-4939