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The impact of ¹⁸F-FDG PET/CT on assessment of nasopharyngeal carcinoma at diagnosis

¹ Department of Diagnostic Radiology & Organ Imaging, ² Department of Clinical Oncology, ³ Hong Kong Adventist Hospital, ⁴ Centre for Clinical Trials, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong S.A.R, China

Correspondence: Dr A D King, Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong S.A.R, China. E-mail: king2015{at}cuhk.edu.hk

The aim of this study was to determine whether the use of whole-body ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography (PET)/CT alters staging and management of nasopharyngeal carcinoma (NPC) when compared with current staging practice. 52 patients with Stage III–IV NPC without distant metastases on chest X-ray/CT, abdominal ultrasound or bone scan were recruited for the study. Whole-body ¹⁸F-FDG PET/CT and MRI of the head and neck were performed. The scans were compared for extent of the primary tumour (PT), cervical nodal metastases (CNM) and distant metastases (DM). Any discordance in results was assessed with respect to staging and impact on management. MRI and ¹⁸F-FDG PET/CT scans were discordant in 28 (54%) patients. There was discordance in the extent of PT at 28 sites; in all sites, MRI showed more extensive tumour involving the nasopharynx (n = 8), skull base (n = 14), brain (n = 4) and orbit (n = 2). There was also variation among the extent of CNM in four nodes of the retropharyngeal region, with the nodes being positive on MRI. ¹⁸F-FDG PET /CT did not identify any additional distant metastases but did identify a second primary tumour in the colon. The additional use of ¹⁸F-FDG PET/CT did not "up-stage" the overall stage or change management in any patient. In conclusion, there is discordance between MRI and ¹⁸F-FDG PET/CT, and the additional use of ¹⁸F-FDG PET/CT for the current assessment of NPC at diagnosis does not appear to be justified in this cohort of patients.