Response evaluation after chemoradiotherapy for advanced nodal disease in head and neck cancer using diffusion-weighted MRI and 18F-FDG-PET–CT

Summary Objectives Evaluation of accuracy and interobserver variation of diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDGPET–CT) to detect residual lymph node metastases after chemoradiotherapy (CRT) in advanc...

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Published in:Oral oncology 2015-05, Vol.51 (5), p.541-547
Main Authors: Schouten, Charlotte S, de Graaf, Pim, Alberts, Femke M, Hoekstra, Otto S, Comans, Emile F.I, Bloemena, E, Witte, Birgit I, Sanchez, E, Leemans, C. René, Castelijns, Jonas A, de Bree, Remco
Format: Article
Language:English
Subjects:
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - therapy
Chemoradiotherapy
Diffusion-weighted MRI
Female
Fluorodeoxyglucose F18
Head and neck cancer
Head and Neck Neoplasms - pathology
Head and Neck Neoplasms - therapy
Hematology, Oncology and Palliative Medicine
Humans
Lymphatic Metastasis
Magnetic Resonance Imaging
Male
Multimodal Imaging
Neoplasm recurrence, regional
Otolaryngology
Positron emission tomography–computed tomography
Positron-Emission Tomography
Tomography, X-Ray Computed
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Summary:Summary Objectives Evaluation of accuracy and interobserver variation of diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDGPET–CT) to detect residual lymph node metastases after chemoradiotherapy (CRT) in advanced staged head and neck squamous cell carcinoma (HNSCC). Materials and methods Retrospectively, routinely performed DW-MRI ( n = 73) and 18F-FDG-PET–CT ( n = 58) 3 months after CRT in HNSCC-patients with advanced nodal disease (N2–N3) were assessed by two radiologists and two nuclear medicine physicians (individually and in consensus). Imaging was scored dichotomously and on a five-point Likert scale. We also explored different scenarios for the potential added value of DW-MRI to PET–CT using the consensus Likert scale. Histopathology and a follow-up of 9 months after CRT served as reference standard. Results Five patients (7%) had residual regional disease. DW-MRI showed a sensitivity of 60% and a specificity of 93%, vs. 100% and 84% for PET–CT, respectively. DW-MRI and PET–CT observers had ‘moderate’ and ‘substantial’ interobserver agreement ( κ = 0.58 and κ = 0.64, respectively) with the dichotomous system. The combination of PET–CT and DW-MRI showed a sensitivity of 100% and a specificity of 95%. Conclusion The high sensitivity of PET–CT authorizes a neck dissection in all patients with a positive test result and the high specificity of DW-MRI justifies avoidance of invasive neck dissections if the test is negative. Interobserver agreement varied as a function of test positivity criteria. Adding DW-MRI to PET–CT seemed to increase the specificity of PET–CT alone, thereby ensuring that less patients are exposed to unnecessary neck dissections.
ISSN:1368-8375
1879-0593
DOI:10.1016/j.oraloncology.2015.01.017