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Cancers
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PET/CT in Head and Neck Cancer
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PET/CT in Head and Neck Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 10385

Special Issue Editor

Dr. Sam Payabvash

E-Mail Website
Guest Editor
Department of Radioogy and Biomedica Imaging, Yale University, 333 Cedar Street, P.O. Box 208042, New Haven, CT 06520, USA
Interests: brain tumors; head and neck tumors; radiomics; machine learning; artificical intelligence

Special Issue Information

Dear Colleagues,

Head and neck cancers are among the most common malignancies worldwide. Identification of novel imaging biomarkers in head and neck cancer is crucial to improve detection, prognostication, therapeutic planning, and surveillance. CT scans provide information regarding the anatomic boundaries and soft tissue characteristics of tumors, whereas PET scans evaluate the metabolic activity of tumoral tissue. Combination of these two modalities provides unique multimodal information regarding the primary tumor, potential associated malignant lymphadenopathy, and/or remote metastasis. Additionally, recent advancements in radiomics and machine learning have opened new doors to the application of quantitative and automated analysis of PET/CTs in oncologic imaging. This Special Issue focuses on applications of PET/CT imaging in diagnosis, risk stratification, and treatment planning of head and neck cancers.

We are pleased to invite you to contribute to this Special Issue of Cancers on “PET/CT Imaging in Head and Neck Cancer”. PET/CTs provide valuable multimodal information regarding the tumor extent, heterogeneity, and biological activity of head and neck tumors. Importantly, recent advancements in radiomics and machine learning have opened new doors to the application of quantitative and automated analysis of PET/CTs in oncologic imaging. The aim is to have a collection of at least 10 articles, and this Special Issue can be printed in book form if this number is reached.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Pharyngeal/laryngeals cancers;
  • Thyroid carcinomas;
  • Salivary gland tumors;
  • Head and neck melanomas;
  • Cervical lymphomas;
  • Upper esophageal cancers;
  • Parathyroid cancers.

I look forward to receiving your contributions.

Dr. Sam Payabvash
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pharyngeal carcinomas
  • thyroid cancer
  • parathyroid carcinoma
  • salivary gland tumors
  • melanoma
  • lymphoma
  • PET/CT

Published Papers (6 papers)

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Research

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10 pages, 2289 KiB  
Article
Increased Pituitary Fluorine-18-Fluorodeoxyglucose Uptake in Patients with Differentiated Thyroid Cancer in Hypothyroidism versus under Recombinant Human Thyroid-Stimulating Hormone Stimulation
by Xinyi Shi, Ilaria Giordani, Marie Nicod Lalonde and Gerasimos P. Sykiotis
Cancers 2024, 16(7), 1382; https://doi.org/10.3390/cancers16071382 - 31 Mar 2024
Viewed by 502
Abstract
Background: 18F-FDG PET/CT is performed for the assessment of radioactive iodine non-avid disease in patients with DTC. In patients prepared by THW, increased pituitary uptake of 18F-FDG in the absence of pituitary disease may reflect the physiological activation of pituitary thyrotroph [...] Read more.
Background: 18F-FDG PET/CT is performed for the assessment of radioactive iodine non-avid disease in patients with DTC. In patients prepared by THW, increased pituitary uptake of 18F-FDG in the absence of pituitary disease may reflect the physiological activation of pituitary thyrotroph cells by hypothyroidism. This study aimed to compare pituitary 18F-FDG uptake in patients with DTC under THW vs. rhTSH stimulation. Methods: A total of 57 patients with DTC undergoing 18F-FDG PET/CT (40 under THW and 17 under rhTSH stimulation) were retrospectively analyzed. Pituitary metabolism was expressed as maximum standardized uptake value (SUVmax) and as SUVratio using the right cerebellum as reference. Results: Pituitary hypermetabolism (SUVmax ≥ 4.1) was present in more patients in the THW group compared to the rhTSH group (62.5% vs. 23.5%; p = 0.01). Pituitary metabolism was significantly higher in the THW group compared to the rhTSH group, as assessed by either SUVmax (mean ± SD: 4.61 ± 1.22, 95%CI: 4.22–5.00 vs. 3.34 ± 0.86, 95%CI: 2.9–3.8; p < 0.001) or SUVratio (0.52 ± 0.11, 95%CI: 0.49–0.56 vs. 0.42 ± 0.07, 95%CI: 0.38–0.46; p < 0.001). Serum TSH levels correlated positively with SUVmax (r = 0.41, p < 0.01) and SUVratio (r = 0.44, p < 0.01) in the THW group only. Conclusions: The present findings support the hypothesis that pituitary hypermetabolism on 18F-FDG PET/CT in patients with DTC undergoing THW is a common physiological response to hypothyroidism. Awareness of this physiological hypermetabolism is important to avoid potential pitfalls in image interpretation. Full article
(This article belongs to the Special Issue PET/CT in Head and Neck Cancer)
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11 pages, 1061 KiB  
Article
Clinical Utility of Second-Look FDG PET-CT to Stratify Incomplete Metabolic Response Post (Chemo) Radiotherapy in Oropharyngeal Squamous Cell Carcinoma
by Sarah Billingsley, Zsuzsanna Iyizoba, Russell Frood, Sriram Vaidyanathan, Robin Prestwich and Andrew Scarsbrook
Cancers 2023, 15(2), 464; https://doi.org/10.3390/cancers15020464 - 11 Jan 2023
Cited by 1 | Viewed by 1328
Abstract
Background: Incomplete response on FDG PET-CT following (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC) hinders optimal management. The study assessed the utility of an interval (second look) PET-CT. Methods: Patients with oropharyngeal squamous cell carcinoma cancer (OPSCC) treated with CRT [...] Read more.
Background: Incomplete response on FDG PET-CT following (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC) hinders optimal management. The study assessed the utility of an interval (second look) PET-CT. Methods: Patients with oropharyngeal squamous cell carcinoma cancer (OPSCC) treated with CRT at a single centre between 2013 and 2020 who underwent baseline, response, and second-look PET-CT were included. Endpoints were conversion rate to complete metabolic response (CMR) and test characteristics of second-look PET-CT. Results: In total, 714 patients with OPSCC underwent PET-CT post-radiotherapy. In total, 88 patients with incomplete response underwent second-look PET-CT a median of 13 weeks (interquartile range 10–15 weeks) after the initial response assessment. In total, 27/88 (31%) second-look PET-CTs showed conversion to CMR, primary tumour CMR in 20/60 (30%), and nodal CMR in 13/37 (35%). In total, 1/34 (3%) with stable tumour/nodal uptake at the second-look PET-CT relapsed. Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) of second-look PET-CT were 95%, 49%, 50%, and 95% for tumour and 92%, 50%, 50%, and 92% for nodes, respectively. Primary tumour progression following CMR occurred in one patient, two patients with residual nodal uptake at second-look PET-CT progressed locoregionally, and one patient developed metastatic disease following CMR in residual nodes. Conclusion: Most patients undergoing second-look PET-CT converted to CMR or demonstrated stable PET signal. NPV was high, suggesting the potential to avoid unnecessary surgical intervention. Full article
(This article belongs to the Special Issue PET/CT in Head and Neck Cancer)
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12 pages, 2531 KiB  
Article
Accuracy of Response Assessment FDG PET-CT Post (Chemo)Radiotherapy in HPV Negative Oropharynx Squamous Cell Carcinoma
by Zsuzsanna Iyizoba-Ebozue, Sarah Billingsley, Russell Frood, Sriram Vaidyanathan, Andrew Scarsbrook and Robin J. D. Prestwich
Cancers 2022, 14(19), 4680; https://doi.org/10.3390/cancers14194680 - 26 Sep 2022
Cited by 1 | Viewed by 1181
Abstract
Background: Data on the accuracy of response assessment 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) following (chemo)radiotherapy in patients with oropharynx squamous cell carcinoma (OPSCC) is predominantly based on HPV-positive disease. There is a paucity of data for HPV-negative disease, which has a [...] Read more.
Background: Data on the accuracy of response assessment 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) following (chemo)radiotherapy in patients with oropharynx squamous cell carcinoma (OPSCC) is predominantly based on HPV-positive disease. There is a paucity of data for HPV-negative disease, which has a less favourable prognosis. Methods: 96 patients treated with (chemo)radiotherapy for HPV-negative OPSCC with baseline and response assessment FDG PET-CT between 2013–2020, were analysed. PET-CT response was classified as negative, equivocal, or positive based on qualitative reporting. PET-CT response categories were analysed with reference to clinicopathological outcomes. Test characteristics were evaluated, comparing negative results to equivocal and positive results together. Post-test probabilities were calculated separately for positive and equivocal or negative results. Results: Median follow-up was 26 months. The negative predictive value of a negative scan was 93.7 and 93.2%, respectively, for primary tumour and nodal disease. For a negative scan, the post-test probability was 0.06 for primary and 0.07 for nodal disease. The post-test probability of an equivocal scan was 0.51 and 0.72 for primary and lymph node, respectively. The post-test probability of a positive scan approached 1. For patients with/without a negative scan, two-year overall survival and progression-free survival were 83% versus 30% and 79% versus 17% (p < 0.001), respectively. Conclusion: The NPV of a negative response assessment PET-CT in HPV-negative OPSCC is high, supporting a strategy of clinical monitoring. Contrasting with the published literature for HPV-positive OPSCC, an equivocal response scan was associated with a moderate rate of residual disease. Full article
(This article belongs to the Special Issue PET/CT in Head and Neck Cancer)
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Review

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34 pages, 3641 KiB  
Review
PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms
by Sinan Akay, Janet H. Pollard, Assim Saad Eddin, Aiah Alatoum, Sedat Kandemirli, Ali Gholamrezanezhad, Yusuf Menda, Michael M. Graham and Ahmad Shariftabrizi
Cancers 2023, 15(15), 3759; https://doi.org/10.3390/cancers15153759 - 25 Jul 2023
Cited by 2 | Viewed by 2378
Abstract
Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis [...] Read more.
Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a “metabolic biopsy” in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse. Full article
(This article belongs to the Special Issue PET/CT in Head and Neck Cancer)
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16 pages, 3489 KiB  
Review
Role of PET/CT in Oropharyngeal Cancers
by Emily W. Avery, Kavita Joshi, Saral Mehra and Amit Mahajan
Cancers 2023, 15(9), 2651; https://doi.org/10.3390/cancers15092651 - 08 May 2023
Cited by 3 | Viewed by 2188
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) comprises cancers of the tonsils, tongue base, soft palate, and uvula. The staging of oropharyngeal cancers varies depending upon the presence or absence of human papillomavirus (HPV)-directed pathogenesis. The incidence of HPV-associated oropharyngeal cancer (HPV + OPSCC) is [...] Read more.
Oropharyngeal squamous cell carcinoma (OPSCC) comprises cancers of the tonsils, tongue base, soft palate, and uvula. The staging of oropharyngeal cancers varies depending upon the presence or absence of human papillomavirus (HPV)-directed pathogenesis. The incidence of HPV-associated oropharyngeal cancer (HPV + OPSCC) is expected to continue to rise over the coming decades. PET/CT is a useful modality for the diagnosis, staging, and follow up of patients with oropharyngeal cancers undergoing treatment and surveillance. Full article
(This article belongs to the Special Issue PET/CT in Head and Neck Cancer)
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13 pages, 260 KiB  
Review
PET/CT May Assist in Avoiding Pointless Thyroidectomy in Indeterminate Thyroid Nodules: A Narrative Review
by Gaby Abou Karam and Ajay Malhotra
Cancers 2023, 15(5), 1547; https://doi.org/10.3390/cancers15051547 - 28 Feb 2023
Cited by 1 | Viewed by 1629
Abstract
Indeterminate thyroid nodules (ITN) are commonly encountered among the general population, with a malignancy rate of 10 to 40%. However, many patients may be overtreated with futile surgery for benign ITN. To avoid unnecessary surgery, PET/CT scan is a possible alternative to help [...] Read more.
Indeterminate thyroid nodules (ITN) are commonly encountered among the general population, with a malignancy rate of 10 to 40%. However, many patients may be overtreated with futile surgery for benign ITN. To avoid unnecessary surgery, PET/CT scan is a possible alternative to help differentiate between benign and malignant ITN. In this narrative review, the major results and limitations of the most recent studies on PET/CT efficacy (from PET/CT visual assessment to quantitative PET parameters and recent radiomic features analysis) and on cost-effectiveness (compared to other alternatives (such as surgery)) are presented. PET/CT can reduce futile surgery with visual assessment (around 40%; if ITN ≥ 10 mm). Moreover, PET/CT conventional parameters and radiomic features extracted from PET/CT imaging can be associated together in a predictive model to rule out malignancy in ITN, with a high NPV (96%) when certain criteria are met. Even though promising results were obtained in these recent PET/CT studies, further studies are needed to enable PET/CT to become the definitive diagnostic tool once a thyroid nodule is identified as indeterminate. Full article
(This article belongs to the Special Issue PET/CT in Head and Neck Cancer)
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