Effect of PET/CT on Surgical Planning for Head and Neck Cancer


Key Points

  • The negative predictive value of PET/CT was 0.942.
  • PET/CT findings changed planned surgical treatment in 21% of patients.

In a study reported in the Journal of Clinical Oncology, Lowe et al found that 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (PET/CT) had a high negative predictive value in the clinically N0 neck in patients with newly diagnosed head and neck squamous cell carcinoma, with results frequently altering surgical plans. 

Study Details

The study included 287 patients with at least one clinically N0 neck side with planned dissection from 23 American College of Radiology Imaging Network–qualified institutions. PET/CT was compared with findings at neck dissection. All eligible patients had T2 to T4 disease.

Negative Predictive Value and Effect on Planned Surgery

PET/CT scans and pathology findings were available for 268 N0 neck sides from 210 patients. On visual assessment, the negative predictive value for the clinical N0 neck sides was 0.868. For dichotomized maximum standardized uptake value on PET/CT, the negative predictive values for nodal basins were 0.940 and 0.937 at prespecified cutoffs of 2.5 and 3.5. At the optimal cutoff maximum standardized uptake value of 1.8, negative predictive value was 0.942. On the basis of PET/CT findings, planned surgical treatment prior to PET/CT was changed in 51 (21%) of 234 patients, including planned dissection of additional nodal levels in 29 patients (12%) and fewer planned dissected nodal levels in 12 (5%). Negative PET/CT in the clinically N0 neck was true negative in 87%, and false negative in 13%.

The investigators concluded: “[18F-fluorodeoxyglucose–PET/CT] has high negative predictive value for the N0 neck in T2 to T4 head and neck squamous cell carcinoma. The surgical treatment plans on the basis of PET/CT findings may be changed in approximately 21% of this group. These findings suggest that [18F-fluorodeoxyglucose–PET/CT] may assist the clinician in deciding on the best therapy for the clinically N0 neck in head and neck squamous cell carcinoma. Well-designed clinical trials should be performed to test the outcome of omitting neck dissection by using PET/CT.”

Val J. Lowe, MD, of the Department of Radiology at the Mayo Clinic, Rochester, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute. The study authors' full disclosures can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.