Diagnostic Value of FDG-PET/CT for the Identification of Extranodal Extension in Patients With Head and Neck Squamous Cell Carcinoma

Abstract

Background/Aim: We evaluated the diagnostic value of functional imaging with [¹⁸F]-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) for the identification of extranodal extension (ENE) in patients with head and neck squamous cell carcinoma (HNSCC). Patients and Methods: In this study, 94 patients with HNSCC who underwent FDG-PET/CT were enrolled. We recorded the maximum standardized uptake value (SUV_max), compared the results with pathologic findings, and evaluated the diagnostic performance of using a SUV_max cut-off value for ENE. Results: Of the 566 dissected levels examined, 53 (9.4%) exhibited ENE. The mean SUV_max of LN with and without ENE were 6.67 and 1.64, respectively (p<0.001). A receiver operating characteristics (ROC) curve analysis for SUV_max showed an area under the ROC curve of 0.913. A SUV_max cut-off of 3.0 achieved diagnostic performance for identifying ENE with sensitivity, specificity, and accuracy of 81.1%, 94.3% and 93.1%, respectively. Conclusion: FDG-PET/CT findings using a SUV_max cut-off of 3.0 provides appropriate diagnostic value in identifying ENE.