The value of preoperative 18F-FDG PET/CT for the assessing contralateral neck in head and neck cancer patients with unilateral node metastasis (N1-3)

ObjectivesThe purpose of this study was to determine whether preoperative F-18-FDG PET/CT is useful in assessing contralateral lymph node metastasis in the neck. DesignA retrospective review of medical records was performed. SettingPatients treated at a single institute. ParticipantsOne hundred and fifty-seven patients whose pathology results were positive for unilateral node metastasis (N1-3) involvement and underwent preoperative F-18-FDG PET/CT for head and neck squamous cell carcinoma (HNSCC) were reviewed. Main outcome measuresPrognostic factors and nodal SUVmax were studied to identify the risk of contralateral disease. ResultsThirty-six (22.9%) patients had contralateral cervical lymph node metastases. The F-18-FDG PET/CT had a sensitivity of 80% and a specificity of 96% in identifying the contralateral cervical lymph node metastases on a level-by-level basis. The median SUVmax values of the ipsilateral and contralateral lymph nodes were 3.993.36 (range, 0-20.4) and 2.94 +/- 2.04 (range, 0-8.7), respectively (P=0.001). There was a significant difference in the median SUVmax of contralateral nodes between the benign and malignant cervical lymph nodes (2.31 +/- 0.62 versus 3.28 +/- 2.43, P=0.014). The cut-off value of contralateral median SUVmax in the context of contralateral cervical metastasis was 2.5 with the sensitivity of 75% and the specificity of 94%. A median contralateral lymph node SUV(max)2.5 was associated with 5-year disease-specific survival (P=0.038). Conclusion(18)F-FDG PET/CT median SUVmax cut-off values of contralateral lymph nodes 2.5 were associated with contralateral cervical lymph node metastases and 5-year disease-specific survival in HNSCC patients with unilateral metastases.