Comparable Accuracy of Quantitative and Visual Analyses of [(18)F]FDG PET/CT for the Detection of Lymph Node Metastases from Head and Neck Squamous Cell Carcinoma

Background: In head and neck squamous cell carcinoma (HNSCC), [(18)F]FDG PET/CT is recommended for detecting recurrent disease and in the initial staging for evaluating distant metastases, but its use in detecting cervical lymph metastases remains unclear. The aim of this study is to evaluate and compare the diagnostic accuracy of [(8)F]FDG-PET/CT using visual and semi-quantitative analyses for detecting the nodal involvement in HNSCC. Methods: We analyzed consecutive patients who underwent a preoperative [(18)F]FDG-PET/CT and neck dissection for HNSCC at our tertiary hospital. A blinded evaluation of the [(18)F]FDG uptake in each neck level was performed using a semi-quantitative approach (SUVmax and SUVR) and a visual grading system (uptake superior to the internal jugular vein for grade 1 and superior to the liver for grade 2). Analyses were compared to the histological results. Results: In our 211 patients, analyses demonstrated similar diagnostic accuracy using a semi-quantitative approach or a visual grading system. Regarding the visual grading system, [(18)F]FDG-PET/CT detected nodal metastases with a specificity of 83% for lymph nodes classified as grade 1 and 98% for those classified as grade 2. The sensitivity was moderate, ranging from 60 to 63%. Conclusions: [(18)F]FDG PET/CT has a high specificity for detecting lymph node metastases in HNSCC and therefore must be considered in the nodal clinical staging.