It is the last day of the EHNS Head and Neck Cancer Awareness Week!
FDG-PET/CT plays a central role in head and neck cancer at several stages of the diagnostic and treatment process. It has been shown that adding FDG-PET/CT to the staging workup results in a higher staging accuracy mainly in patients with suspicious lymph nodes or high stage tumours. Especially nodal classification and detection of distant metastases is improved when FDG-PET/CT is added to the diagnostic workup, aiding clinical decision making. Performing FDG-PET/CT can aid patient selection for additional treatment options in the future, as it has been shown that patients with a high metabolic active tumour have a worse prognosis.
It plays an important role in radiotherapy treatment planning as well, which can be personalized based on the metabolic tumour volume of the primary tumour and the presence of suspicious lymph nodes. FDG-PET/CT has a high negative predictive value showing residual tumour after finishing treatment, which means that additional treatment (e.g. neck dissection) can be omitted in patients with a negative PET/CT after finishing treatment. Although it is not indicated in routine follow-up, when there is clinical suspicion, FDG-PET/CT can detect recurrent disease in an early stage. It is also recommended to perform FDG-PET/CT in patients with unknown primary tumours who present with cervical metastases.
Standardization of imaging protocols, interpretation and reporting (e.g. based on Hopkins criteria) are all important aspects in providing high accuracy in the all above mentioned aspects of FDG-PET/CT in head and neck cancer. To ensure adequate image interpretation and optimal incorporation of the imaging results in the treatment plan, the nuclear medicine physician should be regular member of the multidisciplinary tumour board.
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