18f-fdg Pet/ct Versus Human Papillomavirus, P16, And Epstein-barr Virus Detection In Cervical Metastatic Lymph Nodes For Identifying Primary Tumors

Presentation: S009
Topic: Oropharynx
Type: Oral
Date: Sunday, July 17, 2016
Session: 10:45 AM - 12:15 PM Imaging and Detection
Authors: Gi Cheol Park, MD1, Jong-Lyel Roh, MD, PhD2, Kyung-Ja Cho, MD, PhD3, Jae Seung Kim, MD, PhD4, Seung-Ho Choi, MD, PhD2, Soon Yuhl Nam, MD, PhD2, Sang Yoon Kim, MD, PhD2
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Institution(s): 1Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea, 2Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, 3Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, 4Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Purpose: Squamous cell carcinoma of unknown primary of the head and neck (SCCUP) is a heterogenous disease entity and scrutinization to find hidden primary is essential prior to definitive treatments. Therefore, we examined the diagnostic value of 18F-FDG PET/CT versus biomarkers such as human papilloma virus (HPV), p16, and Epstein-Barr virus (EBV) expression in metastatic lymph nodes.

Patients and methods: We prospectively enrolled 54 patients with SCCUP who received 18F-FDG PET/CT and HPV, p16, and EBV examinations from lymph node fine-needle aspirates and subsequently underwent palatine tonsillectomy and guided biopsy to detect primary tumors. The diagnostic performance of 18F-FDG PET/CT and biomarkers were calculated and compared using receiver operating characteristics (ROC) curve analyses with histopathological results as the reference for primary tumors.

Results: Primary tumors were identified at 28 of 54 patients (52%): 24 patients in the palatine tonsil, 1 patient in the base of the tongue, 2 patients in the nasopharynx, and 1 patient in the hypopharynx. The sensitivity of p16, HPV, and 18F-FDG PET/CT was 85.7%, 71.4%, and 42.9%, respectively, and these specificity was 80.8%, 100%, and 96.2%, respectively. The sensitivity of p16 and the accuracy of HPV were higher than those of 18F-FDG PET/CT (p <0.05). Area under the ROC curve analysis of HPV was higher than that of 18F-FDG PET/CT (0.857 vs 0.695, p=0.013). The patients with primary tumor detection or p16 nodal immunopositivity showed higher disease-free survival rates than the counter parts (p <0.05).

Conclusion: This prospective study shows that detection of HPV and p16 from metastatic lymph nodes can help identify hidden primary tumors as to guide definitive treatments and predict patient survival.

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