NEW YORK (Reuters Health) - Using positron emission tomography (PET) scanning in patients with metastatic head and neck cutaneous squamous cell cancer (cSCC) appears to have no benefit, according to new research from Australia.
PET scanning is not cost-efficient and can actually delay necessary treatment, the authors reported online January 13 in American Journal of Otolaryngology.
"Adding PET-CT scan to investigate patients with head and neck skin squamous cell cancer that has spread to nodes in the neck does not add to what's known by conventional scans such as MRI or CT scans," said main author Dr. Mrinal Supriya of Wayne State University in Detroit, Michigan, in email to Reuters Health.
"The study findings advocate against using PET-CT scans in staging these patients," he said.
Locating no prior studies addressing the use of PET-CT to help manage this group of patients, Dr. Supriya and his colleagues conducted their own retrospective study of eligible patients managed over two years at one cancer treatment center in Australia.
They compared staging by whole-body positron fluorine-18 fluorodeoxyglucose positron emission tomography scanning (18F-FDG PET-CT) with staging by conventional methods alone.
After excluding patients with regional nodal recurrence, the researchers had data on 28 males and three females with a mean age of 73 (range 58 to 87) who had confirmed cSCC with regional head and neck nodal metastasis.
They compared the patients' original treatment plan, based on conventional MRI and CT imaging and physical exam, with their final treatment plan that added the PET scan.
In the three high-impact patients, the PET-CT scan findings led to a change in treatment intent or modality; in the four medium-impact patients, the PET-CT scan findings led to a change in the extent of surgery or radiotherapy. In the 20 low-impact patients, the PET-CT scan, MRI and CT findings agreed, so patient management did not change; and in the four no-impact patients, the PET-CT scan findings were ignored.
Although the extent of surgery was increased based on the PET-CT scan results in four patients (one from the high impact group and three from medium impact group), the pathology was truly positive in only half of these.
Adding the PET scan did not change the management in 24 of 31 patients (77%).
In four no-impact patients, the PET scan failed to detect biopsy-proven metastatic disease.
The PET scan results, compared with the final pathology result after resection in 25 patients who had surgery, showed a sensitivity of 54% and specificity of 76%, equating to a positive predictive value of 61% and a negative predictive value of 71%.
Senior author Dr. Andrew Sizeland of Peter MacCallum Cancer Institute in Melbourne, Australia, said in an email, "Clinical examination and imaging by CT or MRI gave the most useful information in terms of planning the extent of surgery in treating advanced non-melanoma cSCC of the head and neck. PET did not offer much more additional treatment planning information in these patients."
"We would not now routinely perform PET studies of patients with advanced head and neck non-melanoma cutaneous SCC," he said.
"These findings need to be validated through further studies at other centers, Dr. Supriya concluded in an email.
Australia has the highest rate of cutaneous cancer in the world, with age-standardized incidence rates estimated at 884 per 100,000 for basal cell cancer and 387 per 100,000 for cutaneous squamous cell cancer; and management of non-melanoma skin cancer consumes the greatest cost of any single cancer care in Australia, the authors wrote in their study.
SOURCE: http://bit.ly/1c7iu8H
Am J Otolaryngol 2014
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