PET and Nuclear Medicine Imaging Agents: Nuclear imaging ..

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We recommend that patients with an equivocal FDG uptake should continue to undergo neck dissection, especially if they have HPV-negative disease. However, patients with HPV-positive cancers who have enlarged nodes but no FDG uptake after chemoradiotherapy may be considered for close follow-up with serial CT or PET-CT; this strategy may spare even more patients from undergoing a neck dissection.

You may also choose to pursue additional credentials in fields such as CT and PET scanning.

Nuclear Medicine; PET Scanning;

23. Waldron J, Gilbert R, Eapen L, et al. Results of an Ontario Clinical Oncology Group (OCOG) prospective cohort study on the use of FDG PET/CT to predict the need for neck dissection following radiation therapy of head and neck cancer (HNC). Presented at the 2011 Annual Meeting of the American Society of Clinical Oncology, Chicago, June 3–7, 2011. abstract.

10. Gupta T, Master Z, Kannan S, et al. Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis. ;38:-


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All treating hospitals were required to be approved as head and neck treatment centers by the U.K. Department of Health. Formalin-fixed, paraffin-embedded tumor samples were tested centrally for p16 expression by means of immunohistochemical analysis with the use of proprietary reagents (CINtec Histology kit, Roche). Testing to detect p16 expression was recorded as positive if more than 70% of the malignant cells showed strong diffuse nuclear and cytoplasmic staining. All PET-CT scans, 10% of other radiologic investigations, and 10% of histologic specimens were reviewed centrally by experienced specialists (details are provided in the ).

Authors: Dr Michael Hofman* Dr Dee Nandurkar * What is a PET scan

All PET-CT findings were interpreted locally by PET-CT specialty radiologists and nuclear-medicine physicians. PET-CT scans were assessed qualitatively. Results of PET-CT that showed intense FDG uptake at 12 weeks after chemoradiotherapy, with or without enlarged lymph nodes in the neck, were classified as incomplete nodal responses. Mild or no FDG uptake in enlarged nodes or mild FDG uptake in normal-sized nodes was considered to be an equivocal response. All other PET-CT scans were considered to show complete responses.

PET stands for “positron emission tomography”

Combined morphologic and functional imaging with the use of combined 18F-fluorodeoxyglucose (FDG) positron-emission tomography and computed tomography (PET-CT) can identify both structural and metabolic abnormalities in tumors. Meta-analyses of mainly small, single-center PET-CT studies involving patients with squamous-cell carcinoma of the head and neck who have received chemoradiotherapy have shown high negative predictive values of 94.5 to 96.0%. Stratification of these patients for neck dissection with the use of PET-CT after chemoradiotherapy may therefore result in fewer neck dissections and a reduced incidence of complications. However, data from prospective, randomized, multicenter trials to support routine adoption of this approach are lacking. We therefore performed a prospective, randomized, controlled trial to compare the clinical usefulness and health economic outcomes of planned neck dissection versus PET-CT–guided surveillance in patients with nodal stage N2 or N3, metastasis stage M0 disease.

Positron emission tomography - Wikipedia

Survival was similar among patients who underwent PET-CT–guided surveillance and those who underwent planned neck dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective. (Funded by the National Institute for Health Research Health Technology Assessment Programme and Cancer Research UK; PET-NECK Current Controlled Trials number, .)