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Vol. 40. Issue 4.
Pages 229-238 (July - August 2021)
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Vol. 40. Issue 4.
Pages 229-238 (July - August 2021)
Original Article
DOI: 10.1016/j.remnie.2020.06.013
18F-FDG-PET/CT in laryngeal cancer: comparison with conventional imaging and prognostic role
La PET/TC con 18F-FDG en el cáncer de laringe: comparación con técnicas de imagen convencional y valor pronóstico
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Domenico Albanoa,
Corresponding author
doalba87@libero.it

Corresponding author.
, Francesco Dondia, Alberto Padernob, Giorgio Nocivellic, Marta Maddalod, Stefano Maria Magrinid, Piero Nicolaib, Roberto Maroldic, Raffaele Giubbinia, Francesco Bertagnaa
a Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
b Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia and Spedali Civili Brescia, Brescia, Italy
c Department of Radiology, University of Brescia and Spedali Civili Brescia, Brescia, Italy
d Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italy
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Tables (5)
Table 1. Main features of study population.
Table 2. Metabolic PET/CT parameters cutoff calculated using receiver operating characteristic (ROC) curve analysis considering the entire population.
Table 3. Results of PET/CT and CI studies of the neck.
Table 4. Results of PET/CT and CI studies of the neck (level-by-level analysis).
Table 5. Univariate and multivariate analyses for PFS and DSS.
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Abstract
Objective

The aim of this study was to investigate the diagnostic accuracy of staging 18 F-FDG-PET/CT in laryngeal cancer, compare these results with conventional imaging (CI) and assess the value of 18 F-FDG-PET/CT features to predict survival.

Methods

Fifty-four patients with laryngeal squamous cell cancer and baseline 18 F-FDG-PET/CT were retrospectively enrolled. The PET images were analyzed visually and semi-quantitatively by measuring several metabolic parameters. A combination of clinical follow-up/imaging follow-up and/or histopathology was taken as reference standard. Progression free survival (PFS) and disease specific survival (DSS) were computed using Kaplan-Meier curves.

Results

All primary tumors were clearly identified by CI, and 52/54 by 18 F-FDG-PET/CT with a sensitivity of 96.3%. Cervical nodal metastases were detected in 40/54 patients at 18 F-FDG-PET/CT and in 34/49 patients at CI. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy on a patient-based analysis for nodal disease were 100%, 85.7%, 94.6%, 100% and 95.9% at 18 F-FDG-PET/CT, and 91.4%, 85.7%, 94.1%, 80%, 89.8% at CI. Diagnostic performances of PET/CT and CI were not significantly different on a patient-based, side-by-side and level-by-level analysis. 18 F-FDG-PET/CT recognized distant metastases in 7 patients allowing to an upstaging. At a median follow-up of 27 months, relapse/progression of disease occurred in 31 patients and death occurred in 32. Metabolic tumor volume (MTV T), MTV total and total lesion glycolysis (TLG) showed to be independent prognostic factors for PFS.

Conclusions

Both CI and PET/CT had good diagnostic performances for the staging of laryngeal cancer; baseline metabolic features (MTV and TLG) showed an important prognostic value in assessing the rate of PFS.

Keywords:
PET/CT
18F-FDG
Prognosis
Laryngeal cancer
Comparison
Resumen
Objetivo

El objetivo de este estudio fue investigar la precisión diagnóstica de la PET/TC con 18 F-FDG en la estadificación del cáncer de laringe, comparar estos resultados con las técnicas de imagen convencional (CI) y evaluar los parámetros metabólicos para predecir la supervivencia.

Métodos

Estudio retrospectivo que incluye cincuenta y cuatro pacientes con cáncer escamoso de laringe que acudieron para realización de estadificación mediante PET/TC con 18 F-FDG. Las imágenes PET se analizaron visualmente y secmicuantitativamente midiendo varios parámetros metabólicos. Se tomó como estándar de referencia el seguimiento clínico, por imagen y/o histopatología. Se calculó el tiempo libre de enfermedad y la supervivencia mediante curvas de Kaplan-Meier.

Resultados

Todos los tumores fueron identificados por las CI y 52/54 por la PET/TC con 18 F-FDG, con sensibilidad del 96,3%. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión, basada en el análisis por paciente para la detección de enfermedad ganglionar fue del: 100%, 85,7%, 94,6%, 100% y 95,9% para la PET/TC con 18 F-FDG y del 91,4%, 85,7%, 94,1%, 80% y 89,9% para las CI. El rendimiento diagnóstico de la PET/TC y las CI no fue significativamente diferente ni en análisis por paciente, ni en el de la lateralización ni el de los niveles ganglionares. La PET/TC con 18 F-FDG detecto metástasis a distancia en 7 pacientes que permitieron una estadificación superior. En una mediana de seguimiento de 27 meses, la recaida/progresión de la enfermedad ocurrió en 31 pacientes y la muestra en 32. El volumen metabólico tumoral (VMT) y la glucolisis total (TLG) de la lesión primaria se mostraron como factores pronósticos independientes para el tiempo libre de enfermedad.

Conclusiones

Tanto las CI como la PET/TC con 18 F-FDG mostraron resultados diagósticos en la estadificación del cáncer de laringe. Los parámetros metabólicos basales (MTV y TLG) mostraron valor pronóstico en la evaluación del tiempo libre de enfermedad.

Palabras clave:
PET/CT
18F-FDG
Pronostico
Cancer de laringe
Comparacion

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