Prof. Hassan Mahmoud Hassan Kasim :: Publications:

Objectives: To re-verify the value of whole body (WB) PET/CT in management of head and neck cancer (HNC) and to assess the clinical feasibility of limited above diaphragm PET/CT. Methods: Retrospectively we reviewed 200 WB PET/CT scans of 180 patients with HNC (15-81 years, average 53.1±12.5, 132 male and 48 female) in our institution from Dec. 2009 to August 2012. These include 100 patients’ nasopharyngeal carcinomas (NPC) and 80 head and neck squamous cell carcinomas (HNSCC). In each scan, the lesions below the diaphragm were recorded and correlated with available pathological result, imaging modalities or follow-up PET/CT. Results: Metastatic lesions from HNC below diaphragm were identified in 9 patients out of 180 (5%). Two patients with HNSCC out of 80 (2.5%) had below diaphragm metastasis. One patient with tongue SCC with metastatic cervical lymph nodes (LN) had only metastatic osseous lesions in lumbar vertebrae below the diaphragm which proved histopathologically to be SCC. The other patient had maxillary SCC with lung and liver metastasis. Seven patients out 100 NPC (7%) had metastasis below the diaphragm. Out of these 7 patients with metastatic NPC, 4 patients had hepatic and portahepatis LN metastasis, patients had both hepatic and adrenal metastasis as seen in FDG PET/CT and CT, one patient had multiple abdominal and pelvic LN, hepatic, splenic and osseous metastatic lesions. The management of disease was changed based on the findings below the level of diaphragm in one subject (1.25%) with HNSCC (the patient had the primary tongue SCC and cervical lymph nodes with only lumbar metastasis) and two patients (2%) with NP had no metastatic lesions above the level of the diaphragm. Conclusions: We concluded that PET/CT imaging below the level of the diaphragm in HNSCC is of no significant added value. Therefore, performing above diaphragm is suggested. However, WB PET/CT imaging in NPC appears to be the appropriate imaging protocol for this population due to higher yield (10.8 %,) of relevant findings below the level of the diaphragm.