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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >The role of positron emission tomography scans in the management of the N-positive neck in head and neck squamous cell carcinoma after chemoradiotherapy.
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The role of positron emission tomography scans in the management of the N-positive neck in head and neck squamous cell carcinoma after chemoradiotherapy.

机译：正电子发射断层扫描在化放疗后头颈部鳞状细胞癌的N阳性颈部处理中的作用。

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OBJECTIVE: The objective of this study was to determine the sensitivity, specificity, and predictive value of 18-fluorodeoxyglucose positron emission tomography (PET) in predicting residual cervical metastatic disease in patients with N-positive necks undergoing curative radiotherapy and chemoradiotherapy for squamous cell carcinoma (SCC) of the upper aerodigestive tract. METHODS: The authors studied a prospective case series of patients (2003-2005) of patients undergoing radiotherapy and chemoradiotherapy for advanced head and neck SSC. Study entry criteria included N-positive neck disease, a complete response to treatment at the primary tumor site, posttreatment PET scan (8-12 weeks after completion of treatment), followed by salvage neck dissection. The posttreatment PET scan neck findings were correlated to the salvage neck dissection pathology report. The sensitivity, specificity, and predictive values of the PET scan to predict residual cervical metastatic disease after curative chemoradiotherapywere calculated. RESULTS: Twenty-one neck dissections (pretreatment N1 = 5, N2a = 2, N2b = 8, N3 = 6) were entered into the protocol. Four (19.0%) of the 21 neck specimens were positive for residual cervical metastatic disease, whereas the remaining 17 (80.9%) specimens demonstrated no residual carcinoma. The overall sensitivity and specificity were 75.0% and 64.7%, respectively. The positive predictive value was 33% and the negative predictive value was 91.7%. CONCLUSIONS: Although the role of posttreatment neck dissection remains controversial, the surgeon must rely on clinical examination and imaging studies. Our practice has been to perform planned staged neck dissections on all N2 and N3 necks, as well as N1 necks with an incomplete response to treatment. Based on this small prospective study, it appears that PET imaging lacks adequate sensitivity and specificity to reliably predict the presence of residual cervical metastatic disease after completion of chemoradiotherapy. With a negative predictive value of 91.7%, however, a negative PET scan appears to be a reliable predictor of the absence of residual tumor.
机译：目的：本研究的目的是确定18氟脱氧葡萄糖正电子发射断层扫描（PET）对N阳性颈部正接受根治性放疗和放化疗的N阳性颈部患者残留宫颈转移性疾病的敏感性，特异性和预测价值。 （SCC）上呼吸消化道。方法：作者研究了一系列前瞻性病例系列（2003-2005年），这些患者接受了晚期头颈SSC放疗和放化疗的患者。研究入选标准包括N阳性颈部疾病，对原发肿瘤部位的治疗有完全反应，治疗后PET扫描（治疗完成后8-12周），然后进行抢救性颈部清扫术。治疗后PET扫描颈部的发现与抢救性颈部解剖病理报告相关。计算了PET放疗预测治愈性放化疗后残留宫颈转移性疾病的敏感性，特异性和预测值。结果：二十一颈清扫术（预处理N1 = 5，N2a = 2，N2b = 8，N3 = 6）被纳入方案。 21例颈部标本中有4例（19.0％）残留宫颈转移病呈阳性，而其余17例（80.9％）标本无残留癌变。总体敏感性和特异性分别为75.0％和64.7％。阳性预测值为33％，阴性预测值为91.7％。结论：尽管治疗后颈部夹层的作用仍存在争议，但外科医生必须依靠临床检查和影像学检查。我们的做法是对所有N2和N3颈部以及N1颈部进行计划的分期颈部解剖，对治疗的反应不完全。根据这项小规模的前瞻性研究，看来PET成像缺乏足够的敏感性和特异性，无法可靠地预测放化疗完成后是否残留宫颈转移性疾病。然而，PET扫描阴性时，阴性预测值为91.7％，可作为没有残留肿瘤的可靠预测指标。

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