Nasopharyngeal carcinoma staging by (18)F-fluorodeoxyglucose positron emission tomography

Chang, Joseph Tung-Chieh; Chan, Sheng-Chieh; Yen, Tzu-Chen; Liao, Chun-Ta; Lin, Chien-Yu; Lin, Kun-Ju; Chen, I.-How; Wang, Hung-Ming; Chang, Yu-Chen; Chen, Tsung-Ming; Kang, Chung-Jan; Ng, Shu-Hang

doi:10.1016/j.ijrobp.2004.09.057

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 62, Issue 2 , Pages 501-507, 1 June 2005

Nasopharyngeal carcinoma staging by (18)F-fluorodeoxyglucose positron emission tomography

Joseph Tung-Chieh Chang, M.D., M.H.A.
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Sheng-Chieh Chan, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Tzu-Chen Yen, M.D., Ph.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Chun-Ta Liao, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Ear Nose and Throat, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Chien-Yu Lin, M.D.
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Kun-Ju Lin, M.D., Ph.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
I.-How Chen, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Ear Nose and Throat, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Hung-Ming Wang, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Yu-Chen Chang, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Tsung-Ming Chen, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Ear Nose and Throat, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Chung-Jan Kang, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Ear Nose and Throat, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Shu-Hang Ng, M.D.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of First Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Reprint requests to: Shun-Hang Ng, M.D., Department of First Radiology, Chang Gung Memorial Hospital, 5 Fu-Shin St., Taoyuan 333 Taiwan. Tel: (+886)-3-211-8247; Fax: (+886)-3-211-8247

Received 17 May 2004; received in revised form 17 September 2004; accepted 22 September 2004. published online 31 January 2005.

Purpose: Nasopharyngeal carcinoma (NPC) has a high rate of neck lymph node and/or distant metastasis. We evaluated the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in staging NPC, especially in the detection of distant metastasis.

Methods and materials: A total of 95 patients, including 85 with primary and 10 with recurrent, NPC were enrolled. Dual-phase FDG-PET was used, in addition to the conventional workup. Eighty-one patients without distant metastases underwent repeat studies 3–4 months after initial radical treatment.

Results: Of 14 patients with distant metastases, all had lesions detected by FDG-PET, and the conventional workup detected the metastases in only 4. Two patients had false-positive MRI findings for neck node metastasis, but the FDG-PET findings were accurate. Four patients without distant metastases on their initial workup were found to have new lesions on FDG-PET 3–4 months after initial treatment. Patients with advanced node disease had a significantly greater incidence of distant metastases on FDG-PET, especially for N3 disease. Of the 95 patients, the FDG-PET results for distant metastasis were true positive in 14 patients, false positive in 8, and true negative in 73. None of our patients had a false-negative result. For a patient base, the sensitivity and specificity of FDG-PET for distant metastasis was 100% and 90.1% (95% confidence interval 81.5–95.6%), respectively, in this study. The accuracy was 91.6% (95% confidence interval 84.1–96.3%), the positive predictive value was 63.6 (95% confidence interval 40.7–82.8%), and the negative predictive value was 100%.

Conclusion: FDG-PET stages N and M disease of NPC more accurately and sensitively than does the conventional workup. Patients with advanced node disease, particularly N3 disease, would benefit the most from FDG-PET.

Keywords: FDG-PET , Nasopharyngeal carcinoma , TNM staging , Metastases , Conventional workup