Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: The role of US, MRI and FDG-PET/TC scans to assess residual neck disease

Raul Pellini, Valentina Manciocco, Mario Turri-Zanoni, Antonello Vidiri, Giuseppe Sanguineti, Laura Marucci, Rosa Sciuto, Renato Covello, Isabella Sperduti, Ramy Kayal, Vincenzo Anelli, Barbara Pichi, Giuseppe Mercante, Giuseppe Spriano

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective To investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).

Methods From 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique.

Results Metastatic disease was assessed in 18/37 (48.6%) hemi-necks, always localized in levels II-IV. US showed greater sensitivity (77.8%) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3%). US, MRI and FDG-PET/TC scans showed the highest specificity (100%), accuracy (93.8%) and positive predictive values (100%).

Conclusions In the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended.

Original languageEnglish
Pages (from-to)1834-1839
Number of pages6
JournalJournal of Cranio-Maxillofacial Surgery
Volume42
Issue number8
DOIs
Publication statusPublished - Dec 1 2014

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Oropharyngeal Neoplasms
Squamous Cell Neoplasms
Neck Dissection
Chemoradiotherapy
Positron-Emission Tomography
Neck
Magnetic Resonance Imaging
Squamous Cell Carcinoma
Observation
Costs and Cost Analysis
Sensitivity and Specificity
Therapeutics

Keywords

  • Chemoradiotherapy
  • FDG-PET-CT
  • Neck ultrasound
  • Oropharyngeal cancer
  • Planned neck dissection

ASJC Scopus subject areas

  • Oral Surgery
  • Otorhinolaryngology
  • Surgery

Cite this

Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer : The role of US, MRI and FDG-PET/TC scans to assess residual neck disease. / Pellini, Raul; Manciocco, Valentina; Turri-Zanoni, Mario; Vidiri, Antonello; Sanguineti, Giuseppe; Marucci, Laura; Sciuto, Rosa; Covello, Renato; Sperduti, Isabella; Kayal, Ramy; Anelli, Vincenzo; Pichi, Barbara; Mercante, Giuseppe; Spriano, Giuseppe.

In: Journal of Cranio-Maxillofacial Surgery, Vol. 42, No. 8, 01.12.2014, p. 1834-1839.

Research output: Contribution to journalArticle

Pellini, Raul ; Manciocco, Valentina ; Turri-Zanoni, Mario ; Vidiri, Antonello ; Sanguineti, Giuseppe ; Marucci, Laura ; Sciuto, Rosa ; Covello, Renato ; Sperduti, Isabella ; Kayal, Ramy ; Anelli, Vincenzo ; Pichi, Barbara ; Mercante, Giuseppe ; Spriano, Giuseppe. / Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer : The role of US, MRI and FDG-PET/TC scans to assess residual neck disease. In: Journal of Cranio-Maxillofacial Surgery. 2014 ; Vol. 42, No. 8. pp. 1834-1839.
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title = "Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: The role of US, MRI and FDG-PET/TC scans to assess residual neck disease",
abstract = "Objective To investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).Methods From 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique.Results Metastatic disease was assessed in 18/37 (48.6{\%}) hemi-necks, always localized in levels II-IV. US showed greater sensitivity (77.8{\%}) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3{\%}). US, MRI and FDG-PET/TC scans showed the highest specificity (100{\%}), accuracy (93.8{\%}) and positive predictive values (100{\%}).Conclusions In the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended.",
keywords = "Chemoradiotherapy, FDG-PET-CT, Neck ultrasound, Oropharyngeal cancer, Planned neck dissection",
author = "Raul Pellini and Valentina Manciocco and Mario Turri-Zanoni and Antonello Vidiri and Giuseppe Sanguineti and Laura Marucci and Rosa Sciuto and Renato Covello and Isabella Sperduti and Ramy Kayal and Vincenzo Anelli and Barbara Pichi and Giuseppe Mercante and Giuseppe Spriano",
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TY - JOUR

T1 - Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer

T2 - The role of US, MRI and FDG-PET/TC scans to assess residual neck disease

AU - Pellini, Raul

AU - Manciocco, Valentina

AU - Turri-Zanoni, Mario

AU - Vidiri, Antonello

AU - Sanguineti, Giuseppe

AU - Marucci, Laura

AU - Sciuto, Rosa

AU - Covello, Renato

AU - Sperduti, Isabella

AU - Kayal, Ramy

AU - Anelli, Vincenzo

AU - Pichi, Barbara

AU - Mercante, Giuseppe

AU - Spriano, Giuseppe

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Objective To investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).Methods From 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique.Results Metastatic disease was assessed in 18/37 (48.6%) hemi-necks, always localized in levels II-IV. US showed greater sensitivity (77.8%) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3%). US, MRI and FDG-PET/TC scans showed the highest specificity (100%), accuracy (93.8%) and positive predictive values (100%).Conclusions In the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended.

AB - Objective To investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).Methods From 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique.Results Metastatic disease was assessed in 18/37 (48.6%) hemi-necks, always localized in levels II-IV. US showed greater sensitivity (77.8%) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3%). US, MRI and FDG-PET/TC scans showed the highest specificity (100%), accuracy (93.8%) and positive predictive values (100%).Conclusions In the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended.

KW - Chemoradiotherapy

KW - FDG-PET-CT

KW - Neck ultrasound

KW - Oropharyngeal cancer

KW - Planned neck dissection

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