18 F-FDG PET/CT Volumetric Metabolic Parameters in the Staging of Head and Neck Squamous Cell Carcinoma

The 18 F-FDG PET/CT (FDG PET) represents a staging method of head and neck squamous cell cancers (HNSCC). Maximum standardized uptake value (SUVmax) is usually used as a benchmark, in contrast, there are few studies examining the efficacy of volumetric metabolic parameters such as Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG). The aim of this study is to evaluate the positive predictive value of SUVmax, MTV and TLG in staging HNSCC, and to estimate a threshold value for the detection of cervical lymph node metastasis by ROC curve. A retrospective study was conducted by analyzing the data of patients who underwent FDG PET for staging HNSCC between 2015 and 2022 at the Nuclear Medicine Unit of the University Hospital of Ferrara. All patients had at least one cytologic or histologic confirmation of the primary tumor and suspicious cervical lymph nodes. We enrolled 89 patients (69 males, 20 females). Preoperative MTV and TLG values on T were significantly higher in patients who developed distant recurrence post-treatment (p <.001; p =.041, respectively). ROC curve analysis on lymph node uptake showed that TLG had a sensitivity of 76% and specificity of 97% in identifying lymph node metastasis at staging, with a cut-off value of 10.150. FDG PET is an effective tool in staging HNSCCs. Volumetric metabolic parameters (MTV and TLG) have proven useful as complementary methods to SUVmax in HNSCC staging.