口腔扁平上皮癌頸部リンパ節転移の評価におけるFDG-PET/造影CTの有用性と限界

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  • Usefulness and limitations of FDG-PET/contrast-enhanced CT in evaluating cervical lymph node metastasis in patients with oral squamous cell carcinoma
  • コウコウ ヘンペイ ジョウヒ ガン ケイブ リンパセツ テンイ ノ ヒョウカ ニ オケル FDG-PET/ゾウエイ CT ノ ユウヨウセイ ト ゲンカイ

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<p>Cervical lymph node metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC), and preoperative evaluation of cervical lymph nodes requires high diagnostic accuracy. We investigated the usefulness of FDG-PET/contrast-enhanced CT for diagnosing cervical lymph node metastasis in OSCC and determined which procedures could be additionally performed to improve diagnostic accuracy. Between April 2005 and March 2013, a total of 115 patients with OSCC who were treated in the Department of Oral and Maxillofacial Surgery, Dokkyo Medical University Hospital participated in this study. The primary sites of OSCC were the tongue (n = 66), mandibular gingiva (n = 27), maxillary gingiva (n = 10), floor of the mouth (n = 6), and buccal mucosa (n = 6). The clinical stage of the disease was stage I in 10 cases, stage II in 35 cases, stage III in 17 cases, and stage IV in 53 cases. Uptake of FDG was elevated in the cervical lymph nodes of 48 patients, among whom 45 had cervical metastasis (true-positive) and three did not (false-positive). Among 67 patients who did not have elevated FDG uptake, 8 patients had cervical metastasis (false-negative) and 59 patients did not (true-negative). The sensitivity, specificity, and accuracy of FDG-PET at a threshold SUVmax of 2.0 were 84.9%, 95.2%, and 90.4%, respectively. A re-evaluation of patients with negative FDG-PET/contrast-enhanced CT findings together with palpation and MRI increased the diagnostic performance to 93.6%, the sensitivity to 94.5%, and the specificity to 94.1% accuracy.</p><p> In conclusion, FDG-PET/contrast-enhanced CT was very useful for diagnosing cervical lymph node metastasis in OSCC. Furthermore, palpation and MRI combined with FDG-PET/contrast-enhanced CT is recommended to reduce the rate of false-negative findings.</p>

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