HNSCC: F18-FDG-PET/CT shows high NPV for clinically N0 neck

  • Lowe VJ & al.
  • J Clin Oncol
  • 15 Feb 2019

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Results from the ACRIN 6685 trial indicate that 18F fluorodeoxyglucose (F18-FDG) positron emission tomography/CT (PET/CT) has >86% negative predictive value (NPV) for clinically N0 neck in patients with head and neck squamous cell carcinoma (HNSCC).

Why this matters

  • A high NPV can help avoid unnecessary treatment.

Key results

  • The NPV for clinical N0 neck sides was 0.868 (95% CI, 0.803-0.925) by visual assessment.
  • At prespecified cutoffs of 2.0, 2.5, and 3.5, the NPVs specific to nodal basins of the neck region were 0.941 (95% CI, 0.930-0.953), 0.940 (95% CI, 0.928-0.952), and 0.937 (95% CI, 0.925-0.949), respectively.
  • At the optimum cutoff of 1.8 (identified by receiver operating characteristic analysis), the NPV for nodal basins was 0.942 (95% CI, 0.930-0.953).
  • Surgical treatment plans were changed in 51/237 evaluable patients (21.5%) based on PET/CT findings.
    • In 34 patients, this led to planned dissection of additional nodal levels.
    • In 6 patients, this led to planned dissection of fewer nodal levels.
    • In 4 patients, this led to both additional and fewer planned dissection of nodal levels.
    • In 6 patients, surgery was cancelled.

Study design

  • 287 patients with HNSCC from 23 sites were included.
  • Funding: National Cancer Institute.

Limitations

  • Lack of central pathology review of all patients.

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