PET/CT versus triple endoscopy in initial workup of HPV+ oropharyngeal squamous cell carcinoma

Head Neck. 2022 May;44(5):1164-1171. doi: 10.1002/hed.27016. Epub 2022 Feb 25.

Abstract

Background: Synchronous primary tumors (SPTs) are detected via triple endoscopy or positron emission tomography/computed tomography (PET/CT). Patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) lack risk factors for SPTs.

Methods: We performed a single institution retrospective review of the efficacy of triple endoscopy and PET/CT in HPV+ OPSCC patients.

Results: Sixty-five HPV+ OPSCC patients underwent triple endoscopy and PET/CT. Patients were white (n = 48, 72.7%), male (n = 53, 81.5%), mean 58.7 ± 8.1 years old. SPT was detected in 1 (1.5%) patient via PET/CT. No SPTs were detected on triple endoscopy. PET/CT had 100% and 95.3% sensitivity and specificity, respectively. PET/CT positive predictive value (PPV) and negative predictive value (NPV) were 25.0% and 100%, respectively. Triple endoscopy specificity and NPV was 90.2% and 93.2%, respectively.

Conclusions: PET/CT is superior to triple endoscopy in ruling out SPTs. With negative PET/CT, only direct laryngoscopy with biopsy may be necessary.

Keywords: HPV-related oropharyngeal cancer; PET/CT; cancer; endoscopy; head and neck cancer.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell* / pathology
  • Endoscopy
  • Fluorodeoxyglucose F18
  • Head and Neck Neoplasms* / complications
  • Humans
  • Male
  • Middle Aged
  • Oropharyngeal Neoplasms* / pathology
  • Papillomavirus Infections* / complications
  • Papillomavirus Infections* / pathology
  • Positron Emission Tomography Computed Tomography / methods
  • Retrospective Studies
  • Squamous Cell Carcinoma of Head and Neck / complications
  • Squamous Cell Carcinoma of Head and Neck / diagnostic imaging

Substances

  • Fluorodeoxyglucose F18