FDG-PET in the clinically negative neck in oral squamous cell carcinoma

Objective. With improved diagnostic imaging techniques, it remains difficult to reduce occult metastatic disease in oral squamous cell carcinoma (SCC) to less than 20%. Therefore, supraomohyoid neck dissection (SOHND) still is a valuable staging procedure in these patients. Methods: Patients with clinically and ultrasonographically staged cN0 SCC of the oral cavity underwent FDG-PET before SOHND. Histologic examination of neck dissection specimens was used as a "gold standard." Results: Twenty-eight consecutive patients were included, representing 30 necks. Occult metastatic disease was found in 30% of SOHND specimens. Average diameter of metastatic deposits was 4.3 mm. Sensitivity, specificity, and accuracy of FDG-PET was 33%, 76%, and 63%, respectively. Conclusions: In patients with cN0 SCC of the oral cavity, FDG-PET does not contribute to the preoperative workup. FDG-PET does not replace SOHND as a staging procedure.