Impact of FDG-PET/CT imaging on nodal staging for head-and-neck squamous cell carcinoma

Int J Radiat Oncol Biol Phys. 2007 Jun 1;68(2):377-82. doi: 10.1016/j.ijrobp.2006.12.032. Epub 2007 Feb 22.


Purpose: To evaluate the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging on nodal staging for head-and-neck squamous cell carcinoma (SCC).

Methods and materials: The study population consisted of 23 patients with head-and-neck SCC who were evaluated with FDG-PET/CT and went on to neck dissection. Two observers consensually determined the lesion size and maximum standardized uptake value (SUVmax) and compared the results with pathologic findings on nodal-level involvement. Two different observers (A and B) independently performed three protocols for clinical nodal staging. Methods 1, 2, and 3 were based on conventional modalities, additional visual information from FDG-PET/CT images, and FDG-PET/CT imaging alone with SUV data, respectively.

Results: All primary tumors were visualized with FDG-PET/CT. Pathologically, 19 positive and 93 negative nodal levels were identified. The SUVmax overlapped in negative and positive nodes <15 mm in diameter. According to receiver operating characteristics analysis, the size-based SUVmax cutoff values were 1.9, 2.5, and 3.0 for lymph nodes <10 mm, 10-15 mm, and >15 mm, respectively. These cutoff values yielded 79% sensitivity and 99% specificity for nodal-level staging. For Observer A, the sensitivity and specificity in Methods 1, 2, and 3 were 68% and 94%, 68% and 99%, and 84% and 99%, respectively, and Method 3 yielded significantly higher accuracy than Method 1 (p = 0.0269). For Observer B, Method 3 yielded the highest sensitivity (84%) and specificity (99%); however, the difference among the three protocols was not statistically significant.

Conclusion: Imaging with FDG-PET/CT with size-based SUVmax cutoff values is an important modality for radiation therapy planning.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / secondary
  • Female
  • Fluorodeoxyglucose F18*
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / pathology
  • Humans
  • Lymphatic Metastasis / diagnostic imaging
  • Male
  • Middle Aged
  • Neck Dissection
  • Neoplasm Staging / methods
  • Observer Variation
  • Positron-Emission Tomography / methods*
  • ROC Curve
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*


  • Fluorodeoxyglucose F18