- Email: [email protected]
CT scan in orofacial cancer staging
Oral Presentations
Head and neck imaging
O.123 Bisphosphonate-associated jawbone osteomyelitis: Clinical, radiological and histological features A. Bedogni1 , G. Saia2 , L. Chiarini3 , P.F. Nocini3 . 1 Unit of Dentistry and Maxillofacial Surgery, Hospital G.B. Rossi, University of Verona, Italy; 2 Unit of Maxillofacial Surgery, University Hospital of Padova, Italy; 3 Unit of Dentistry and Maxillofacial Surgery, University Hospital of Modena and Reggio Emilia, Italy Introduction and Objectives: Patients taking amino-bisphosphonates may develop jawbone disease. We evaluated the clinical, radiological and histological features of bisphosphonateassociated jawbone disease with the aim of defining the nature of bone lesions and the possible pathogenesis. Methods: Thirty-five consecutive patients with bisphosphonateassociated jawbone disease were studied. Clinical and radiological assessment were performed; the number and features of each lesion and history of previous traumatic events were recorded. Eleven patients underwent extensive jawbone resection. Resected jaws were subjected to histological analysis. Based on CT and MRI findings, bone specimens were obtained from exposed necrotic areas, unexposed areas and resection margins. Results: Sixteen patients had metastatic bone disease and 19 had multiple myeloma without jawbone involvement. Forty-one bone lesions were identified (mandible 29, maxilla 12), corresponding to 1.2 lesions on average per patient. The mean duration of bisphosphonate treatment before diagnosis was 32.8 months. Histologically, the specimens obtained from the areas of exposed bone were typified by non-vital bone, with rough boundaries and empty lacunae, vessels were scanty, without signs of bone remodelling. In contrast, specimens from the areas of unexposed bone were characterized, by a highly vascularized fibrous tissue and inflammatory infiltrate within large intertrabecular spaces; a peculiar feature was the detachment of osteoclasts from bone surfaces. The margins of resected bone showed normal bone structure and vascular supply. Conclusions: Our study suggests that bisphosphonate-associated jawbone disease may be a form of osteomyelitis with peculiar features, possibly caused by interference of bisphosphonates with bone remodeling, rather than avascular osteonecrosis.
Tuesday, 12 September 2006, 14.30−15.00
Hall 4
Head and neck imaging O.124 Clinical benefit of 18 F-FET-PET and 18 FFDG-PET in the diagnosis of head and neck cancer A. Zimmermann1 , D. Pauleit2 , K. Langen2 , N. K¨ubler1 . 1 Department of Cranio- and Maxillofacial Surgery, HeinrichHeine University, D¨usseldorf, Germany; 2 Institute of Medicine and Brain Imaging Center West, Research Center J¨ulich, J¨ulich, Germany To evaluate the clinical benefit of 18 F-FET-PET and 18 F-FDGPET in the diagnosis of head and neck cancer, all previously not histologicaly proven lesions of a patient collective were examined after 1 year. These lesions, now proven for malignancy were used to assess the diagnostic tools. Methods: Thirty two patients with suspected head and neck tumours underwent 18 F-FET-PET, 18 F-FDG-PET and CT. Beside the 32 main lesions, 311 cervical lymph nodes and seven additional clinical findings were evaluated.
35
Results: Histologic examination revealed 25 squamous cell carcinomas (SCC), one adenocarcinoma and one mucoepidermoid carcinoma. Two mandible lesions were metastases of breast cancer and prostate cancer. In 3 patients, inflammatory tissue and no tumour were identified. In three patients 18 F-FDG-PET showed a second tumour at a different anatomic site, as well as 4 thoracic lymph node metastases. The sensitivity of CT for malignant lesions was 69% (20/29). 18 F-FDG-PET and 18 FFET-PET yielded a higher sensitivity of 90% (26/29) and 72% (21/29). 18 F-FET-PET was quite sensitive for SCC and showed 84% (21/25) of these tumours, but no other lesions were detected. Of 311 histologically examined cervical lymph nodes, 19 showed metastatic infiltration. The CT detected 6, 18 F-FDG-PET 8 and 18 F-FET-PET only 4 of these as malignant, but 43 (CT), 12 (18 FFDG-PET) and none (18 F-FET-PET) as false positive. Conclusion: 18 F-FDG-PET alone detected important additional findings, decisive for further therapy. 18 F-FET-PET might better differentiate SCC from other lesions but cannot replace 18 F-FDGPET or CT due to the inferior sensitivity. A combination of the techniques may be helpful in selected patients. O.125 The role of 18-FDG PET/CT scan in orofacial cancer staging J. Walter, D. Hrusak. Division of Maxillo-Facial Surgery, Department of Stomatology, Charles University Hospital Plzen, Czech Republic Introduction and Objectives: 18-fluorodeoxyglucosis Positron Emission Tomography (18-FDG PET) scanning shows the clinical most new modality for imaging of tissues with high proliferation activity. The combination of PET with multi-slice Computer Tomography (CT) scans get the excellent information for diagnostic and treatment planning in many branches of human oncological surgery. The regional lymphatic nodes spreading plays the most important role in orofacial cancer, for treatment options planning and prognosis estimating it is mandatory. Material and Methods: Fifty patients included in the study underwent PET/CT before surgical treatment. The sensitivity and specificity parameters of the PET/CT imaging in correlation with clinical and preoperative results were compared. Statistical evaluation (sensitivity and specifity test) was preformed. Results: The sensitivity and specificity parameters (both more than 90%) shows, the PET/CT imaging get for the staging of nodal spreading, the best results among all possible clinical investigation procedures and helps to determine the optimal treatment options. Conclusions: The study sustained the clinical importance of PET/CT scanning for looking for the presence of subclinical regional lymphatic nodes infiltration (N-stage). The correlation of PET/CT data with histopathological findings of block-neck dissection tissue microscopic investigation demonstrated that PET/CT scan can improve the treatment option in head and neck malignancies.
Head and neck imaging
O.123 Bisphosphonate-associated jawbone osteomyelitis: Clinical, radiological and histological features A. Bedogni1 , G. Saia2 , L. Chiarini3 , P.F. Nocini3 . 1 Unit of Dentistry and Maxillofacial Surgery, Hospital G.B. Rossi, University of Verona, Italy; 2 Unit of Maxillofacial Surgery, University Hospital of Padova, Italy; 3 Unit of Dentistry and Maxillofacial Surgery, University Hospital of Modena and Reggio Emilia, Italy Introduction and Objectives: Patients taking amino-bisphosphonates may develop jawbone disease. We evaluated the clinical, radiological and histological features of bisphosphonateassociated jawbone disease with the aim of defining the nature of bone lesions and the possible pathogenesis. Methods: Thirty-five consecutive patients with bisphosphonateassociated jawbone disease were studied. Clinical and radiological assessment were performed; the number and features of each lesion and history of previous traumatic events were recorded. Eleven patients underwent extensive jawbone resection. Resected jaws were subjected to histological analysis. Based on CT and MRI findings, bone specimens were obtained from exposed necrotic areas, unexposed areas and resection margins. Results: Sixteen patients had metastatic bone disease and 19 had multiple myeloma without jawbone involvement. Forty-one bone lesions were identified (mandible 29, maxilla 12), corresponding to 1.2 lesions on average per patient. The mean duration of bisphosphonate treatment before diagnosis was 32.8 months. Histologically, the specimens obtained from the areas of exposed bone were typified by non-vital bone, with rough boundaries and empty lacunae, vessels were scanty, without signs of bone remodelling. In contrast, specimens from the areas of unexposed bone were characterized, by a highly vascularized fibrous tissue and inflammatory infiltrate within large intertrabecular spaces; a peculiar feature was the detachment of osteoclasts from bone surfaces. The margins of resected bone showed normal bone structure and vascular supply. Conclusions: Our study suggests that bisphosphonate-associated jawbone disease may be a form of osteomyelitis with peculiar features, possibly caused by interference of bisphosphonates with bone remodeling, rather than avascular osteonecrosis.
Tuesday, 12 September 2006, 14.30−15.00
Hall 4
Head and neck imaging O.124 Clinical benefit of 18 F-FET-PET and 18 FFDG-PET in the diagnosis of head and neck cancer A. Zimmermann1 , D. Pauleit2 , K. Langen2 , N. K¨ubler1 . 1 Department of Cranio- and Maxillofacial Surgery, HeinrichHeine University, D¨usseldorf, Germany; 2 Institute of Medicine and Brain Imaging Center West, Research Center J¨ulich, J¨ulich, Germany To evaluate the clinical benefit of 18 F-FET-PET and 18 F-FDGPET in the diagnosis of head and neck cancer, all previously not histologicaly proven lesions of a patient collective were examined after 1 year. These lesions, now proven for malignancy were used to assess the diagnostic tools. Methods: Thirty two patients with suspected head and neck tumours underwent 18 F-FET-PET, 18 F-FDG-PET and CT. Beside the 32 main lesions, 311 cervical lymph nodes and seven additional clinical findings were evaluated.
35
Results: Histologic examination revealed 25 squamous cell carcinomas (SCC), one adenocarcinoma and one mucoepidermoid carcinoma. Two mandible lesions were metastases of breast cancer and prostate cancer. In 3 patients, inflammatory tissue and no tumour were identified. In three patients 18 F-FDG-PET showed a second tumour at a different anatomic site, as well as 4 thoracic lymph node metastases. The sensitivity of CT for malignant lesions was 69% (20/29). 18 F-FDG-PET and 18 FFET-PET yielded a higher sensitivity of 90% (26/29) and 72% (21/29). 18 F-FET-PET was quite sensitive for SCC and showed 84% (21/25) of these tumours, but no other lesions were detected. Of 311 histologically examined cervical lymph nodes, 19 showed metastatic infiltration. The CT detected 6, 18 F-FDG-PET 8 and 18 F-FET-PET only 4 of these as malignant, but 43 (CT), 12 (18 FFDG-PET) and none (18 F-FET-PET) as false positive. Conclusion: 18 F-FDG-PET alone detected important additional findings, decisive for further therapy. 18 F-FET-PET might better differentiate SCC from other lesions but cannot replace 18 F-FDGPET or CT due to the inferior sensitivity. A combination of the techniques may be helpful in selected patients. O.125 The role of 18-FDG PET/CT scan in orofacial cancer staging J. Walter, D. Hrusak. Division of Maxillo-Facial Surgery, Department of Stomatology, Charles University Hospital Plzen, Czech Republic Introduction and Objectives: 18-fluorodeoxyglucosis Positron Emission Tomography (18-FDG PET) scanning shows the clinical most new modality for imaging of tissues with high proliferation activity. The combination of PET with multi-slice Computer Tomography (CT) scans get the excellent information for diagnostic and treatment planning in many branches of human oncological surgery. The regional lymphatic nodes spreading plays the most important role in orofacial cancer, for treatment options planning and prognosis estimating it is mandatory. Material and Methods: Fifty patients included in the study underwent PET/CT before surgical treatment. The sensitivity and specificity parameters of the PET/CT imaging in correlation with clinical and preoperative results were compared. Statistical evaluation (sensitivity and specifity test) was preformed. Results: The sensitivity and specificity parameters (both more than 90%) shows, the PET/CT imaging get for the staging of nodal spreading, the best results among all possible clinical investigation procedures and helps to determine the optimal treatment options. Conclusions: The study sustained the clinical importance of PET/CT scanning for looking for the presence of subclinical regional lymphatic nodes infiltration (N-stage). The correlation of PET/CT data with histopathological findings of block-neck dissection tissue microscopic investigation demonstrated that PET/CT scan can improve the treatment option in head and neck malignancies.