Article Figures & Data
Figures
- Fig 1.
NI-RADS 3 true-positive. A 62-year-old man with advanced HPV-positive oropharyngeal squamous cell carcinoma. A, Pretreatment PET/CT shows 2 areas of FDG-avid infiltrative tumor in the oropharynx, one centered in the right faucial tonsil with invasion of the adjacent right tongue base and right-sided floor of mouth and one centered in the left tongue base. B, Surveillance PET/CT obtained at 3.5 months after completion of treatment shows interval improvement and a decrease in the size of the primary tumor, but there remains a substantial amount of residual FDG avidity in the right-sided floor of the mouth (white arrow), which is suspicious for residual viable tumor. Treatment failure was subsequently confirmed with biopsy.
- Fig 2.
NI-RADS 3 false-positive. A 55-year-old man with metastatic HPV-positive oropharyngeal squamous cell carcinoma. A, Pretreatment PET/CT shows a large FDG-avid right oropharyngeal tumor with FDG-avid right level IIa nodal metastasis. B, Surveillance PET/CT obtained at 2.5 months after completion of treatment shows complete response of the primary tumor, but there remains a large nodal remnant with moderate FDG-avidity (white arrow), which is concerning for residual viable tumor. The patient subsequently underwent right-neck dissection, with final pathology showing treatment-related changes but no viable tumor.
- Fig 3.
NI-RADS 4 true-positive. A 74-year-old man with squamous cell carcinoma of the oral cavity after tumor resection, left-neck dissection, and adjuvant chemoradiation. A, The first surveillance PET/CT obtained at 3.5 months after completion of treatment shows treatment-related changes, with no convincing imaging evidence of viable tumor. B, At 8 months after completion of treatment, there is a new FDG-avid soft-tissue mass in the left upper neck (white arrow), indicative of locoregional tumor recurrence.
- Fig 4.
University of Pittsburgh PET/CT Surveillance Flowchart for Head and Neck Squamous Cell Carcinoma. NI-RADS 1, no evidence of recurrence; NI-RADS 2, low suspicion; NI-RADS 3, high suspicion; NI-RADS 4, definitive disease recurrence. Negative predictive values of first NI-RADS 1 PET/CT = 91%; negative predictive values of 2 consecutive NI-RADS 1 PET/CTs = 98%;5 negative predictive values of the first NI-RADS 2 PET/CT = 85%;10 PPV of NI-RADS 3 PET/CT = 56%; PPV of NI-RADS 4 PET/CT = 100%.
Tables
NI-RADS 3 (n = 128) NI-RADS 4 (n = 69) Sex Male 97 (76%) 51 (74%) Female 31 (24%) 18 (26%) Age (yr) Range = 27–87, mean = 59, median = 60 Range = 26–87, mean = 62, median = 64 Primary tumor location Oropharynx 55 (43%) 21 (30%) Oral cavity 32 (25%) 26 (38%) Larynx 29 (23%) 14 (20%) Hypopharynx 5 (4%) 4 (6%) Paranasal sinuses/nasal cavity 3 (2%) 3 (4%) Nasopharynx 2 (1.5%) 1 (2%) Unknown 2 (1.5%) 0 (0%) HPV status (oropharynx) Positive 32 (58%) 12 (57%) Negative 18 (33%) 2 (10%) Unknown 5 (9%) 7 (33%) TNM stage (7th ed AJCC11) Stage I 3 (2%) 4 (6%) Stage II 12 (10%) 2 (3%) Stage III 20 (16%) 5 (7%) Stage IV 91 (71%) 58 (84%) Unknown primary 2 (1%) 0 (0%) Note:—TNM indicates Tumor, Node, Metastasis.
Time Interval between Completion of Therapy and Posttreatment PET/CT with False-Positive NI-RADS 3 Results No. of Posttreatment PET/CTs with False-Positive NI-RADS 3 Results 0–3 mo 27 (48%) 3–6 mo 10 (18%) 6–12 mo 10 (18%) 1–2 yr 6 (11%) 2–3 yr 0 (0%) 3–4 yr 1 (2%) 4–5 yr 2 (3%)
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