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. 2023 Feb;50(3):881-891.
doi: 10.1007/s00259-022-06020-3. Epub 2022 Oct 27.

Benefit of [18F] FDG PET/CT in the diagnosis and salvage treatment of recurrent nasopharyngeal carcinoma

Pu-Yun OuYang  1 , Zhi-Qiao Liu  1 , Qing-Guang Lin  2 , Yun He  3 , Zhi-Xin Guo  2 , Wen-Yan Yao  1 , Sen-Kui Xu  1 , Qing-He Peng  1 , Su-Ming Xiao  1 , Jiajian Li  4 , Anwei Li  4 , Bao-Yu Zhang  1 , Shan-Shan Yang  5 , Wei Fan  6 , Chuan-Miao Xie  3 , Yi-Shan Wu  7 , Xu Zhang  6 , Chun-Yan Chen  1 , Fang-Yun Xie  8
Affiliations

Benefit of [18F] FDG PET/CT in the diagnosis and salvage treatment of recurrent nasopharyngeal carcinoma

Pu-Yun OuYang et al. Eur J Nucl Med Mol Imaging. 2023 Feb.

Abstract

Purpose: To compare PET/CT, MRI and ultrasonography in detecting recurrence of nasopharyngeal carcinoma and identify their benefit in staging, contouring and overall survival (OS).

Methods: Cohort A included 1453 patients with or without histopathology-confirmed local recurrence, while cohort B consisted of 316 patients with 606 histopathology-confirmed lymph nodes to compare the sensitivities and specificities of PET/CT, MRI and ultrasonography using McNemar test. Cohorts C and D consisted of 273 patients from cohort A and 267 patients from cohort B, respectively, to compare the distribution of PET/CT-based and MRI-based rT-stage and rN-stage and the accuracy of rN-stage using McNemar test. Cohort E included 30 random patients from cohort A to evaluate the changes in contouring with or without PET/CT by related-samples T test or Wilcoxon rank test. The OS of 61 rT3-4N0M0 patients staged by PET/CT plus MRI (cohort F) and 67 MRI-staged rT3-4N0M0 patients (cohort G) who underwent similar salvage treatment were compared by log-rank test and Cox regression.

Results: PET/CT had similar specificity to MRI but higher sensitivity (93.9% vs. 79.3%, P < 0.001) in detecting local recurrence. PET/CT, MRI and ultrasonography had comparable specificities, but PET/CT had greater sensitivity than MRI (90.9% vs. 67.6%, P < 0.001) and similar sensitivity to ultrasonography in diagnosing lymph nodes. According to PET/CT, more patients were staged rT3-4 (82.8% vs. 68.1%, P < 0.001) or rN + (89.9% vs. 69.3%, P < 0.001), and the rN-stage was more accurate (90.6% vs. 73.8%, P < 0.001). Accordingly, the contours of local recurrence were more precise (median Dice similarity coefficient 0.41 vs. 0.62, P < 0.001) when aided by PET/CT plus MRI. Patients staged by PET/CT plus MRI had a higher 3-year OS than patients staged by MRI alone (85.5% vs. 60.4%, P = 0.006; adjusted HR = 0.34, P = 0.005).

Conclusion: PET/CT more accurately detected and staged recurrence of nasopharyngeal carcinoma and accordingly complemented MRI, providing benefit in contouring and OS.

Keywords: MRI; PET/CT; Recurrent nasopharyngeal carcinoma.

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