Background: Head and neck cancer (HNC) is the 7th most common cancer worldwide. HNC tends to present late and requires a multidisciplinary team (MDT) guided multi-modality treatment pathway. Up to 50% of patients with advanced-stage disease develop recurrent or residual disease, usually within the first two years after treatment. Early detection of recurrence is essential to prioritise appropriate patients for salvage treatment. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography and computed tomography (PET-CT) are the gold standard imaging modalities to assess response to treatment for HNC.
Aim: The primary objective of this review is to investigate the diagnostic performance of 18F-FDG PET-CT versus histopathological diagnosis for recurrent or residual disease in head and neck cancer patients who have undergone treatment with radiation therapy.
Methods: The Medline database searched for relevant literature, yielding 542 studies. 21 studies fulfilled the criteria for inclusion in this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines were adapted to conduct the systematic review. Quality appraisal of the included studies was completed using the QUADAS-2 critical appraisal checklist. Data were then analysed using pooled sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV).
Results: Twenty-one studies fulfilled the criteria for inclusion in this systematic review. A total of 2,455 patients underwent a total of 2,321 scans. The pooled sensitivity and specificity of 18F-FDG PET-CT for detecting residual or recurrent HNC were 90% (95% confidence interval, 86-93%) and 83% (95% confidence interval, 80-85%), respectively. The pooled NPV of 18F-FDG PET-CT for detecting residual or recurrent HNC was 96% (95% confidence interval, 94-97%).
Conclusion: This systematic review of the diagnostic performance of 18F-FDG PET-CT versus histopathological diagnosis for recurrent or residual disease in head and neck cancer patients who have undergone radiation therapy treatment reiterates this imaging modality’s utility in detecting residual or recurrent disease.
Khalid Munir1, Tom Moran2,3,4, Fergal O’Duffy2,3,4,
1 Higher Specialty Training Programme Otorhinolaryngology/Head & Neck Surgery, Royal College of Surgeons Ireland
2 Department of Otorhinolaryngology, Head & Neck Surgery, Mater Misericordiae University Hospital, Dublin
3 Department of Otorhinolaryngology, Head & Neck Surgery, University College Dublin, Dublin
4 Department of Otorhinolaryngology, Head & Neck Surgery, St. Vincent’s University Hospital, Dublin