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Use of lymphoscintigraphy in PET in head and neck melanoma
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OtolaryngologyHead and Neck Surgery August 1999
Scientific Sessions--Tuesday
tobacco, snuff, dip, pipe tobacco, cigars, and marijuana. Significant exposure to other carcinogenic chemicals was considered significant if it occurred for at least 8 hours a week for at least l year. Results: Sixty-one patients with SCCHN were identified who had neither smoked nor drank. The average age for the group was 61.2 years, and 98.4% were non-Hispanic whites; 63.9% of this group were females, with 36.1% having a primary of the tongue and only 9% having a laryngeal primary. Significant second-hand tobacco smoke exposure at home and work was reported by 36.1% and 26.2%, respectively; 11.5% were users of other forms of tobacco, and 49.2% of these patients reported an exposure to some carcinogenic chemical other than tobacco or alcohol. We found that 34.4% of these patients had a parent with cancer, 29.5% had a sibling with cancer, and 8.2% had a child develop cancer. Overall, 52.5% had a first-degree relative with cancer, and 57.4% had a second-degree relative with cancer. And 31.1% of these patients had a previous malignancy. Conclusion: According to the American Cancer Society, 28% of new cases of SCCHN diagnosed in the United States in 1999 will occur in females, with 16% occurring in the tongue and 25% in the larynx. Individuals who have never smoked or drank but develop SCCHN are more often females and commonly have primaries of the tongue but not the larynx. Furthermore, they usually have significant reported exposure to other forms of tobacco and/or other carcinogens. Given their high rate of relatives with cancer and their high rate of second malignancies, these patients may represent a group that is genetically susceptible to SCCHN. 10:38 a m
Laryngeal and Hypopharyngeal Cancer: Staging Accuracy of CT and MR Imaging PETER ZBAREN MD (presenter); HUBERT LAENG MD; MINERVA BECKER MD; Berne Switzerland; Aarau Switzerland; Geneva Switzerland
Objectives: To assess the accuracy of preoperative CT and MRI and to analyze the impact of these diagnostic modalities on pretherapeutic staging of laryngeal and hypopharyngeal carcinoma. Methods: A total of 114 consecutive patients with neoplasms of the larynx and hypopharynx, who were treated surgically, were included in a prospective pretherapeutic staging protocol that included contrast-enhanced CT and gadoliniumdiethylenetriamine pentaacetic acid-enhanced MRI at 1.5 Tesla. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were compared with findings of the CT and MR images. Results: MRI was more sensitive in detecting neoplastic invasion of cartilage than CT (96% vs 70%; P = 0.001), whereas CT was more specific than MRI (95% vs 72%; P =
0.007). There was no difference between the overall accuracy of CT and M R / i n detecting neoplastic invasion of cartilage (84% vs 86%). The accuracy of combined clinical/endoscopic examination and CT staging for laryngeal and hypopharyngeal cancers was 80% and 78% and of combined clinical/ endoscopic examination and MR/Staging 87% and 78%. Conclusion: MR/is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. Therefore, MR/tends to overestimate neoplastic cartilage invasion and may result in overtreatment, whereas CT tends to underestimate neoplastic cartilage invasion and therefore may lead to inadequate therapy. 10:46 AM
Use of Lymphoscintigfaphy in PET in Head and Neck Melanoma GARTH T OLSON MD (presenter); BRENDAN C STACK JR MD; Saint Louis MO
Objectives: Lymphoscintigraphy with sentinel node dissection and FDG-PET are being used separately in the management of many intermediate and thick melanomas of the head and neck. We report a series of patients with melanoma of the head and neck with Breslow depths greater than 0.75 ram, which were evaluated with both FDG2 PET and lymphoscintigraphy. The purpose of this study was to compare the rate of detection of occult nodal metastases uncovered by these 2 methods. We also investigated whether information gleaned from these 2 studies allowed us better staging information on which to base further treatment. Methods: Between July 1, 1998, and January 1, 1999, FDG-PET scans were obtained preoperatively in 8 patients undergoing resection of head and neck melanoma. Lymphoscintigraphy was done on the day of surgery by the nuclear medicine department, and a gamma probe was used intraoperatively to detect the sentinel lymph node and other first echelon nodes for removal. Resection of the primary lesion was carried out with adequate margins, and the defects were reconstructed. Results: We found that the use of FDG-PET and lymz phoscintigraphy was effective in detecting locoregional metastasis in our series of head and neck melanoma patients. We were able to successfully resect the sentinel node in all patients. This showed metastasis in 25% of cases, upstaging the patient's disease and allowing eligibility for other adjuvant biologic therapies. FDG-PET detected nodal metastasis preoperatively exclusively in patients with positive sentinel node biopsies. Conclusion: The combined use of modalities to detect metastasis perioperatively in melanoma patients increases our ability to correctly stage patients and provide stage-specific therapies. FDG-PET and lymphoscintigraphy combined may in the future increase the sensitivity of occult metastasis detection.
OtolaryngologyHead and Neck Surgery August 1999
Scientific Sessions--Tuesday
tobacco, snuff, dip, pipe tobacco, cigars, and marijuana. Significant exposure to other carcinogenic chemicals was considered significant if it occurred for at least 8 hours a week for at least l year. Results: Sixty-one patients with SCCHN were identified who had neither smoked nor drank. The average age for the group was 61.2 years, and 98.4% were non-Hispanic whites; 63.9% of this group were females, with 36.1% having a primary of the tongue and only 9% having a laryngeal primary. Significant second-hand tobacco smoke exposure at home and work was reported by 36.1% and 26.2%, respectively; 11.5% were users of other forms of tobacco, and 49.2% of these patients reported an exposure to some carcinogenic chemical other than tobacco or alcohol. We found that 34.4% of these patients had a parent with cancer, 29.5% had a sibling with cancer, and 8.2% had a child develop cancer. Overall, 52.5% had a first-degree relative with cancer, and 57.4% had a second-degree relative with cancer. And 31.1% of these patients had a previous malignancy. Conclusion: According to the American Cancer Society, 28% of new cases of SCCHN diagnosed in the United States in 1999 will occur in females, with 16% occurring in the tongue and 25% in the larynx. Individuals who have never smoked or drank but develop SCCHN are more often females and commonly have primaries of the tongue but not the larynx. Furthermore, they usually have significant reported exposure to other forms of tobacco and/or other carcinogens. Given their high rate of relatives with cancer and their high rate of second malignancies, these patients may represent a group that is genetically susceptible to SCCHN. 10:38 a m
Laryngeal and Hypopharyngeal Cancer: Staging Accuracy of CT and MR Imaging PETER ZBAREN MD (presenter); HUBERT LAENG MD; MINERVA BECKER MD; Berne Switzerland; Aarau Switzerland; Geneva Switzerland
Objectives: To assess the accuracy of preoperative CT and MRI and to analyze the impact of these diagnostic modalities on pretherapeutic staging of laryngeal and hypopharyngeal carcinoma. Methods: A total of 114 consecutive patients with neoplasms of the larynx and hypopharynx, who were treated surgically, were included in a prospective pretherapeutic staging protocol that included contrast-enhanced CT and gadoliniumdiethylenetriamine pentaacetic acid-enhanced MRI at 1.5 Tesla. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were compared with findings of the CT and MR images. Results: MRI was more sensitive in detecting neoplastic invasion of cartilage than CT (96% vs 70%; P = 0.001), whereas CT was more specific than MRI (95% vs 72%; P =
0.007). There was no difference between the overall accuracy of CT and M R / i n detecting neoplastic invasion of cartilage (84% vs 86%). The accuracy of combined clinical/endoscopic examination and CT staging for laryngeal and hypopharyngeal cancers was 80% and 78% and of combined clinical/ endoscopic examination and MR/Staging 87% and 78%. Conclusion: MR/is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. Therefore, MR/tends to overestimate neoplastic cartilage invasion and may result in overtreatment, whereas CT tends to underestimate neoplastic cartilage invasion and therefore may lead to inadequate therapy. 10:46 AM
Use of Lymphoscintigfaphy in PET in Head and Neck Melanoma GARTH T OLSON MD (presenter); BRENDAN C STACK JR MD; Saint Louis MO
Objectives: Lymphoscintigraphy with sentinel node dissection and FDG-PET are being used separately in the management of many intermediate and thick melanomas of the head and neck. We report a series of patients with melanoma of the head and neck with Breslow depths greater than 0.75 ram, which were evaluated with both FDG2 PET and lymphoscintigraphy. The purpose of this study was to compare the rate of detection of occult nodal metastases uncovered by these 2 methods. We also investigated whether information gleaned from these 2 studies allowed us better staging information on which to base further treatment. Methods: Between July 1, 1998, and January 1, 1999, FDG-PET scans were obtained preoperatively in 8 patients undergoing resection of head and neck melanoma. Lymphoscintigraphy was done on the day of surgery by the nuclear medicine department, and a gamma probe was used intraoperatively to detect the sentinel lymph node and other first echelon nodes for removal. Resection of the primary lesion was carried out with adequate margins, and the defects were reconstructed. Results: We found that the use of FDG-PET and lymz phoscintigraphy was effective in detecting locoregional metastasis in our series of head and neck melanoma patients. We were able to successfully resect the sentinel node in all patients. This showed metastasis in 25% of cases, upstaging the patient's disease and allowing eligibility for other adjuvant biologic therapies. FDG-PET detected nodal metastasis preoperatively exclusively in patients with positive sentinel node biopsies. Conclusion: The combined use of modalities to detect metastasis perioperatively in melanoma patients increases our ability to correctly stage patients and provide stage-specific therapies. FDG-PET and lymphoscintigraphy combined may in the future increase the sensitivity of occult metastasis detection.