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PET/CT tops detecting secondary cancers
Replacement for traditional head, neck cancer tests?
Secondary cancers occur in 5-10% of patients with head and neck cancer, but there has been no industry standard for identifying such cancers. Consequently, many centers use numerous tests including ultrasound, X-rays, CT, and blood work to uncover secondary disease. However, new research by Michael Odell, MD, assistant professor of otolaryngology at Saint Louis (MO) University School of Medicine, suggests that positron emission tomography/CT can singlehandedly do at least as good a job as all the other traditional tests put together. And the employment of just a single test, as opposed to many different procedures, can save valuable time as well.
"All the traditional tests have been shown at one point or another to not be perfect, so what we were hoping to do was show that at the very worst, this single modality was equal to all of the varying protocols that are being used elsewhere," explains Odell. To make this determination, investigators reviewed the PET/CT scans of 77 patients and found that four of the patients had secondary cancers. The rate of detection delivered by the PET/CT scans was 7%, which is in line with results from previous studies where the detection rate has ranged from 5% to 10%, according to researchers. They presented their findings at the recent International Conference on Head and Neck Cancer.
The results were not a surprise as PET/CT brings attractive capabilities to the table, emphasizes Odell. "All the other techniques that have been used previously rely on either testing the function of an organ or taking a picture of an organ, but now PET/CT actually does both simultaneously," says Odell, pointing out that when a nodule appears on a PET/CT scan, clinicians can see whether it is functional or non-functional. "If it is non-functional, it is non-issue, and you don't have to go chasing after it because it is not likely to be malignant, so [PET/CT] has simplified things to an extent," he says.
While most of the major medical centers already are using PET/CT as the image modality of choice to identify secondary cancers in head and neck cancer patients, Odell acknowledges that it will take time for the approach to become a standard of care. However, he points out that reimbursement for PET/CT is routine at this point except in cases where PET/CT is being used as a follow-up tool in patients who are in remission. "In the absence of any clinical evidence of recurrence, I am not sure that PET/CT is a terribly high-yield tool," says Odell. "However when I suspect recurrence in someone, then at that point, it is absolutely critical."
Odell further points out that PET/CT should clearly offer the same types of benefits to many other types of cancer. "The bottom line is that almost every cancer of importance that we know of functions at a higher level than normal tissues, and that is what a PET/CT scan is designed to image."