Advantage of PET/CT in target delineation of MRI negative cervical lymph nodes in intensity-modulated radiation therapy planning for nasopharyngeal carcinoma

Guanzhu Shen, Weiwei Xiao, Fei Han, Wei Fan, Xiao ping Lin, Lixia Lu, Lie Zheng, Ning Yue, Bruce Haffty, Chong Zhao, Xiaowu Deng

Research output: Contribution to journalArticle

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Abstract

Introduction: In intensity-modulated radiation therapy (IMRT) planning for nasopharyngeal carcinoma (NPC), cervical lymph nodes (CLNs) that appear negative on magnetic resonance imaging (MRI) scans can be difficult to target. The purpose of this study was to assess the advantage of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) for distinguishing MRI-negative CLNs and the effect of 18F-FDG PET/CT on diagnosis, target delineation, and dose prescription in IMRT planning for NPC. Methods: Thirty-five NPC patients with 37 MRI-negative CLNs underwent 18F-FDG PET/CT imaging before treatment. Ultrasonography-guided fine-needle aspiration cytology (USgFNAC) was performed to examine the pathology of CLNs. The 18F-FDG PET/CT and cytopathological results were compared, and the diagnostic accuracy of 18F-FDG PET/CT was calculated. The cytopathologically confirmed CLNs were delineated and treated as the gross tumor volume of lymph nodes (denoted as GTVnd). Results: Nineteen of the 37 MRI-negative CLNs were positive on 18F-FDG PET/CT, and metastasis was confirmed by USgFNAC in 16 CLNs. Of the remaining 18 18F-FDG PET/CT-negative lymph nodes, metastasis was confirmed in one. The diagnostic accuracy, sensitivity, and specificity of 18F-FDG PET/CT were 89.2%, 94.1%, and 85.0%, respectively. The positive and negative predictive values were 84.2% and 94.4%, respectively. With a median follow-up of 48.3 months, no relapse was observed among the 18F-FDG PET/CT-positive CLNs with metastasis confirmed by USgFNAC and treated as GTVnd. Conclusion: 18F-FDG PET/CT had high accuracy, sensitivity, and specificity for distinguishing MRI-negative CLNs. 18F-FDG PET/CT-positive CLNs could reasonably be categorized as high-risk clinical tumor volume in IMRT planning for NPC.

Original languageEnglish (US)
Pages (from-to)4117-4123
Number of pages7
JournalJournal of Cancer
Volume8
Issue number19
DOIs
StatePublished - Jan 1 2017

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Fluorodeoxyglucose F18
Radiotherapy
Lymph Nodes
Magnetic Resonance Imaging
Fine Needle Biopsy
Cell Biology
Ultrasonography
Neoplasm Metastasis
Tumor Burden
Nasopharyngeal carcinoma
Sensitivity and Specificity
Prescriptions
Pathology

Keywords

  • Cervical lymph nodes
  • F-FDG PET/CT
  • IMRT
  • MRI
  • Nasopharyngeal carcinoma

ASJC Scopus subject areas

  • Oncology

Cite this

Advantage of PET/CT in target delineation of MRI negative cervical lymph nodes in intensity-modulated radiation therapy planning for nasopharyngeal carcinoma. / Shen, Guanzhu; Xiao, Weiwei; Han, Fei; Fan, Wei; Lin, Xiao ping; Lu, Lixia; Zheng, Lie; Yue, Ning; Haffty, Bruce; Zhao, Chong; Deng, Xiaowu.

In: Journal of Cancer, Vol. 8, No. 19, 01.01.2017, p. 4117-4123.

Research output: Contribution to journalArticle

Shen, Guanzhu ; Xiao, Weiwei ; Han, Fei ; Fan, Wei ; Lin, Xiao ping ; Lu, Lixia ; Zheng, Lie ; Yue, Ning ; Haffty, Bruce ; Zhao, Chong ; Deng, Xiaowu. / Advantage of PET/CT in target delineation of MRI negative cervical lymph nodes in intensity-modulated radiation therapy planning for nasopharyngeal carcinoma. In: Journal of Cancer. 2017 ; Vol. 8, No. 19. pp. 4117-4123.
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title = "Advantage of PET/CT in target delineation of MRI negative cervical lymph nodes in intensity-modulated radiation therapy planning for nasopharyngeal carcinoma",
abstract = "Introduction: In intensity-modulated radiation therapy (IMRT) planning for nasopharyngeal carcinoma (NPC), cervical lymph nodes (CLNs) that appear negative on magnetic resonance imaging (MRI) scans can be difficult to target. The purpose of this study was to assess the advantage of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) for distinguishing MRI-negative CLNs and the effect of 18F-FDG PET/CT on diagnosis, target delineation, and dose prescription in IMRT planning for NPC. Methods: Thirty-five NPC patients with 37 MRI-negative CLNs underwent 18F-FDG PET/CT imaging before treatment. Ultrasonography-guided fine-needle aspiration cytology (USgFNAC) was performed to examine the pathology of CLNs. The 18F-FDG PET/CT and cytopathological results were compared, and the diagnostic accuracy of 18F-FDG PET/CT was calculated. The cytopathologically confirmed CLNs were delineated and treated as the gross tumor volume of lymph nodes (denoted as GTVnd). Results: Nineteen of the 37 MRI-negative CLNs were positive on 18F-FDG PET/CT, and metastasis was confirmed by USgFNAC in 16 CLNs. Of the remaining 18 18F-FDG PET/CT-negative lymph nodes, metastasis was confirmed in one. The diagnostic accuracy, sensitivity, and specificity of 18F-FDG PET/CT were 89.2{\%}, 94.1{\%}, and 85.0{\%}, respectively. The positive and negative predictive values were 84.2{\%} and 94.4{\%}, respectively. With a median follow-up of 48.3 months, no relapse was observed among the 18F-FDG PET/CT-positive CLNs with metastasis confirmed by USgFNAC and treated as GTVnd. Conclusion: 18F-FDG PET/CT had high accuracy, sensitivity, and specificity for distinguishing MRI-negative CLNs. 18F-FDG PET/CT-positive CLNs could reasonably be categorized as high-risk clinical tumor volume in IMRT planning for NPC.",
keywords = "Cervical lymph nodes, F-FDG PET/CT, IMRT, MRI, Nasopharyngeal carcinoma",
author = "Guanzhu Shen and Weiwei Xiao and Fei Han and Wei Fan and Lin, {Xiao ping} and Lixia Lu and Lie Zheng and Ning Yue and Bruce Haffty and Chong Zhao and Xiaowu Deng",
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T1 - Advantage of PET/CT in target delineation of MRI negative cervical lymph nodes in intensity-modulated radiation therapy planning for nasopharyngeal carcinoma

AU - Shen, Guanzhu

AU - Xiao, Weiwei

AU - Han, Fei

AU - Fan, Wei

AU - Lin, Xiao ping

AU - Lu, Lixia

AU - Zheng, Lie

AU - Yue, Ning

AU - Haffty, Bruce

AU - Zhao, Chong

AU - Deng, Xiaowu

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Introduction: In intensity-modulated radiation therapy (IMRT) planning for nasopharyngeal carcinoma (NPC), cervical lymph nodes (CLNs) that appear negative on magnetic resonance imaging (MRI) scans can be difficult to target. The purpose of this study was to assess the advantage of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) for distinguishing MRI-negative CLNs and the effect of 18F-FDG PET/CT on diagnosis, target delineation, and dose prescription in IMRT planning for NPC. Methods: Thirty-five NPC patients with 37 MRI-negative CLNs underwent 18F-FDG PET/CT imaging before treatment. Ultrasonography-guided fine-needle aspiration cytology (USgFNAC) was performed to examine the pathology of CLNs. The 18F-FDG PET/CT and cytopathological results were compared, and the diagnostic accuracy of 18F-FDG PET/CT was calculated. The cytopathologically confirmed CLNs were delineated and treated as the gross tumor volume of lymph nodes (denoted as GTVnd). Results: Nineteen of the 37 MRI-negative CLNs were positive on 18F-FDG PET/CT, and metastasis was confirmed by USgFNAC in 16 CLNs. Of the remaining 18 18F-FDG PET/CT-negative lymph nodes, metastasis was confirmed in one. The diagnostic accuracy, sensitivity, and specificity of 18F-FDG PET/CT were 89.2%, 94.1%, and 85.0%, respectively. The positive and negative predictive values were 84.2% and 94.4%, respectively. With a median follow-up of 48.3 months, no relapse was observed among the 18F-FDG PET/CT-positive CLNs with metastasis confirmed by USgFNAC and treated as GTVnd. Conclusion: 18F-FDG PET/CT had high accuracy, sensitivity, and specificity for distinguishing MRI-negative CLNs. 18F-FDG PET/CT-positive CLNs could reasonably be categorized as high-risk clinical tumor volume in IMRT planning for NPC.

AB - Introduction: In intensity-modulated radiation therapy (IMRT) planning for nasopharyngeal carcinoma (NPC), cervical lymph nodes (CLNs) that appear negative on magnetic resonance imaging (MRI) scans can be difficult to target. The purpose of this study was to assess the advantage of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) for distinguishing MRI-negative CLNs and the effect of 18F-FDG PET/CT on diagnosis, target delineation, and dose prescription in IMRT planning for NPC. Methods: Thirty-five NPC patients with 37 MRI-negative CLNs underwent 18F-FDG PET/CT imaging before treatment. Ultrasonography-guided fine-needle aspiration cytology (USgFNAC) was performed to examine the pathology of CLNs. The 18F-FDG PET/CT and cytopathological results were compared, and the diagnostic accuracy of 18F-FDG PET/CT was calculated. The cytopathologically confirmed CLNs were delineated and treated as the gross tumor volume of lymph nodes (denoted as GTVnd). Results: Nineteen of the 37 MRI-negative CLNs were positive on 18F-FDG PET/CT, and metastasis was confirmed by USgFNAC in 16 CLNs. Of the remaining 18 18F-FDG PET/CT-negative lymph nodes, metastasis was confirmed in one. The diagnostic accuracy, sensitivity, and specificity of 18F-FDG PET/CT were 89.2%, 94.1%, and 85.0%, respectively. The positive and negative predictive values were 84.2% and 94.4%, respectively. With a median follow-up of 48.3 months, no relapse was observed among the 18F-FDG PET/CT-positive CLNs with metastasis confirmed by USgFNAC and treated as GTVnd. Conclusion: 18F-FDG PET/CT had high accuracy, sensitivity, and specificity for distinguishing MRI-negative CLNs. 18F-FDG PET/CT-positive CLNs could reasonably be categorized as high-risk clinical tumor volume in IMRT planning for NPC.

KW - Cervical lymph nodes

KW - F-FDG PET/CT

KW - IMRT

KW - MRI

KW - Nasopharyngeal carcinoma

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