FDG-PET/CT for oral focus assessment in head and neck cancer patients

Dominic Raphael Schwaninger; Martin Hüllner; Dominique Bichsel; Barbara Giacomelli-Hiestand; Nicole Selina Stutzmann; Panagiotis Balermpas; Silvio Valdec; Bernd Stadlinger

doi:10.1007/s00784-022-04403-2

FDG-PET/CT for oral focus assessment in head and neck cancer patients

Clin Oral Investig. 2022 Jun;26(6):4407-4418. doi: 10.1007/s00784-022-04403-2. Epub 2022 Mar 7.

Authors

Dominic Raphael Schwaninger¹, Martin Hüllner², Dominique Bichsel¹, Barbara Giacomelli-Hiestand¹, Nicole Selina Stutzmann³, Panagiotis Balermpas⁴, Silvio Valdec¹, Bernd Stadlinger⁵

Affiliations

¹ Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
² Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Zurich, Switzerland.
³ Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
⁴ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁵ Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland. bernd.stadlinger@zzm.uzh.ch.

Abstract

Objectives: To compare oral and maxillo-mandibular inflammatory foci on standard oral radiographs (OPT, periapical radiograph) with available fluorine-18-labelled fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) data and to discuss whether additional metabolic information derived from FDG-PET/CT can support oral care specialists when performing oral focus examinations.

Materials and methods: Data from 23 patients with head and neck cancer who underwent FDG-PET/CT and panoramic and periapical radiography in close succession before first-line radiotherapy and/or chemotherapy were included in this exploratory retrospective study. Periapical lesions and marginal periodontal inflammation on FDG-PET/CT scans and standard oral radiographs were analysed and compared with regard to metabolic activity on FDG-PET/CT in comparison to recorded clinical symptoms and radiological scores. Additionally, inflammatory maxillo-mandibular pathologies were analysed using FDG-PET/CT.

Results: The maximum standardised uptake value (SUV_max) in FDG-avid marginal periodontal sites could not be conclusively associated with the radiologically recorded severity of marginal bone loss, but a potential positive correlation was identified. No association was found either between the metabolic activity of periapical lesions and their extent, as recorded on standard oral radiographs, or regarding clinical symptoms (percussion test). Most maxillo-mandibular pathologies did not show increased FDG uptake.

Conclusions: FDG-PET/CT provided additional metabolic information that can help clinicians identify lesions with increased inflammatory activity. The incorporation of available oral FDG-PET/CT findings into the primary oral focus assessment may allow for more accurate oral focus treatment.

Clinical relevance: FDG-PET/CT provides valuable metabolic information for oral care specialists. The detection of inflammatory oral processes using FDG-PET/CT facilitates treatment.

Keywords: Head and neck cancer; Oral focus; Panoramic radiography; Periapical radiography; Positron emission tomography–computed tomography; Radiochemotherapy.

MeSH terms

Fluorodeoxyglucose F18*
Head and Neck Neoplasms* / diagnostic imaging
Humans
Positron Emission Tomography Computed Tomography / methods
Positron-Emission Tomography / methods
Retrospective Studies

Substances

Fluorodeoxyglucose F18