Is C-11 Methionine PET an alternative to 18-F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy?

Jan Wedman, Jan Pruim, Lisa van der Putten, Otto S. Hoekstra, Remco de Bree, Boukje A. C. van Dijk, Bernard F. A. M. van der Laan

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: 18F FDG-PET is superior to other imaging techniques in revealing residual laryngeal cancer after radiotherapy. Unfortunately, its specificity is low, due to FDG uptake in inflammation and in anaerobic conditions. PET imaging with the amino acid-based radiopharmaceutical C11-methionine (MET) should be less influenced by post-radiation conditions. The aim of this study was to investigate the potential of MET in diagnosing recurrent laryngeal cancer after radiotherapy as compared to 18F-FDG. Methods: Forty-eight patients with a clinical suspicion of local residual disease at least 3 months after completion of radiotherapy or chemoradiotherapy for a T2-4 laryngeal carcinoma, along with an indication for direct laryngoscopy, were included. They received MET-PET and FDG-PET prior to the direct laryngoscopy. One senior nuclear medicine physician assessed both the FDG-PET and MET-PET images visually for the degree of abnormal uptake. The gold standard was a biopsy-proven recurrence 12 months after PET. The nuclear physician had no access to the medical charts and was blinded to the results of the other PET. Sensitivity, specificity and positive and negative predictive value were calculated. Results: The sensitivity of FDG was 77.3% and the specificity 56.0% after the conservative reading, with these values equalling 54.5% and 76.0% for MET. The positive predictive value of FDG was 60.7% and the negative predictive value 73.7%. The PPV of MET was 66.7%, and the NPV was 65.5%. The McNemar test within diseased (sensitivity comparison) shows a p-value of 0.125, and the McNemar test within non-diseased (specificity comparison) shows a P-value of 0.180. Conclusion: MET-PET is not superior to FDG-PET in terms of identifying recurrent laryngeal cancer.
Original languageEnglish
Pages (from-to)124-130
JournalClinical Otolaryngology
Volume44
Issue number2
DOIs
Publication statusPublished - Mar 2019

Cite this

Wedman, J., Pruim, J., van der Putten, L., Hoekstra, O. S., de Bree, R., van Dijk, B. A. C., & van der Laan, B. F. A. M. (2019). Is C-11 Methionine PET an alternative to 18-F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy? Clinical Otolaryngology, 44(2), 124-130. https://doi.org/10.1111/coa.13242
Wedman, Jan ; Pruim, Jan ; van der Putten, Lisa ; Hoekstra, Otto S. ; de Bree, Remco ; van Dijk, Boukje A. C. ; van der Laan, Bernard F. A. M. / Is C-11 Methionine PET an alternative to 18-F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy?. In: Clinical Otolaryngology. 2019 ; Vol. 44, No. 2. pp. 124-130.
@article{471c53671e3f4583bfb590e63d2531a3,
title = "Is C-11 Methionine PET an alternative to 18-F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy?",
abstract = "Objective: 18F FDG-PET is superior to other imaging techniques in revealing residual laryngeal cancer after radiotherapy. Unfortunately, its specificity is low, due to FDG uptake in inflammation and in anaerobic conditions. PET imaging with the amino acid-based radiopharmaceutical C11-methionine (MET) should be less influenced by post-radiation conditions. The aim of this study was to investigate the potential of MET in diagnosing recurrent laryngeal cancer after radiotherapy as compared to 18F-FDG. Methods: Forty-eight patients with a clinical suspicion of local residual disease at least 3 months after completion of radiotherapy or chemoradiotherapy for a T2-4 laryngeal carcinoma, along with an indication for direct laryngoscopy, were included. They received MET-PET and FDG-PET prior to the direct laryngoscopy. One senior nuclear medicine physician assessed both the FDG-PET and MET-PET images visually for the degree of abnormal uptake. The gold standard was a biopsy-proven recurrence 12 months after PET. The nuclear physician had no access to the medical charts and was blinded to the results of the other PET. Sensitivity, specificity and positive and negative predictive value were calculated. Results: The sensitivity of FDG was 77.3{\%} and the specificity 56.0{\%} after the conservative reading, with these values equalling 54.5{\%} and 76.0{\%} for MET. The positive predictive value of FDG was 60.7{\%} and the negative predictive value 73.7{\%}. The PPV of MET was 66.7{\%}, and the NPV was 65.5{\%}. The McNemar test within diseased (sensitivity comparison) shows a p-value of 0.125, and the McNemar test within non-diseased (specificity comparison) shows a P-value of 0.180. Conclusion: MET-PET is not superior to FDG-PET in terms of identifying recurrent laryngeal cancer.",
author = "Jan Wedman and Jan Pruim and {van der Putten}, Lisa and Hoekstra, {Otto S.} and {de Bree}, Remco and {van Dijk}, {Boukje A. C.} and {van der Laan}, {Bernard F. A. M.}",
note = "This article is protected by copyright. All rights reserved.",
year = "2019",
month = "3",
doi = "10.1111/coa.13242",
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Wedman, J, Pruim, J, van der Putten, L, Hoekstra, OS, de Bree, R, van Dijk, BAC & van der Laan, BFAM 2019, 'Is C-11 Methionine PET an alternative to 18-F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy?' Clinical Otolaryngology, vol. 44, no. 2, pp. 124-130. https://doi.org/10.1111/coa.13242

Is C-11 Methionine PET an alternative to 18-F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy? / Wedman, Jan; Pruim, Jan; van der Putten, Lisa; Hoekstra, Otto S.; de Bree, Remco; van Dijk, Boukje A. C.; van der Laan, Bernard F. A. M.

In: Clinical Otolaryngology, Vol. 44, No. 2, 03.2019, p. 124-130.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Is C-11 Methionine PET an alternative to 18-F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy?

AU - Wedman, Jan

AU - Pruim, Jan

AU - van der Putten, Lisa

AU - Hoekstra, Otto S.

AU - de Bree, Remco

AU - van Dijk, Boukje A. C.

AU - van der Laan, Bernard F. A. M.

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/3

Y1 - 2019/3

N2 - Objective: 18F FDG-PET is superior to other imaging techniques in revealing residual laryngeal cancer after radiotherapy. Unfortunately, its specificity is low, due to FDG uptake in inflammation and in anaerobic conditions. PET imaging with the amino acid-based radiopharmaceutical C11-methionine (MET) should be less influenced by post-radiation conditions. The aim of this study was to investigate the potential of MET in diagnosing recurrent laryngeal cancer after radiotherapy as compared to 18F-FDG. Methods: Forty-eight patients with a clinical suspicion of local residual disease at least 3 months after completion of radiotherapy or chemoradiotherapy for a T2-4 laryngeal carcinoma, along with an indication for direct laryngoscopy, were included. They received MET-PET and FDG-PET prior to the direct laryngoscopy. One senior nuclear medicine physician assessed both the FDG-PET and MET-PET images visually for the degree of abnormal uptake. The gold standard was a biopsy-proven recurrence 12 months after PET. The nuclear physician had no access to the medical charts and was blinded to the results of the other PET. Sensitivity, specificity and positive and negative predictive value were calculated. Results: The sensitivity of FDG was 77.3% and the specificity 56.0% after the conservative reading, with these values equalling 54.5% and 76.0% for MET. The positive predictive value of FDG was 60.7% and the negative predictive value 73.7%. The PPV of MET was 66.7%, and the NPV was 65.5%. The McNemar test within diseased (sensitivity comparison) shows a p-value of 0.125, and the McNemar test within non-diseased (specificity comparison) shows a P-value of 0.180. Conclusion: MET-PET is not superior to FDG-PET in terms of identifying recurrent laryngeal cancer.

AB - Objective: 18F FDG-PET is superior to other imaging techniques in revealing residual laryngeal cancer after radiotherapy. Unfortunately, its specificity is low, due to FDG uptake in inflammation and in anaerobic conditions. PET imaging with the amino acid-based radiopharmaceutical C11-methionine (MET) should be less influenced by post-radiation conditions. The aim of this study was to investigate the potential of MET in diagnosing recurrent laryngeal cancer after radiotherapy as compared to 18F-FDG. Methods: Forty-eight patients with a clinical suspicion of local residual disease at least 3 months after completion of radiotherapy or chemoradiotherapy for a T2-4 laryngeal carcinoma, along with an indication for direct laryngoscopy, were included. They received MET-PET and FDG-PET prior to the direct laryngoscopy. One senior nuclear medicine physician assessed both the FDG-PET and MET-PET images visually for the degree of abnormal uptake. The gold standard was a biopsy-proven recurrence 12 months after PET. The nuclear physician had no access to the medical charts and was blinded to the results of the other PET. Sensitivity, specificity and positive and negative predictive value were calculated. Results: The sensitivity of FDG was 77.3% and the specificity 56.0% after the conservative reading, with these values equalling 54.5% and 76.0% for MET. The positive predictive value of FDG was 60.7% and the negative predictive value 73.7%. The PPV of MET was 66.7%, and the NPV was 65.5%. The McNemar test within diseased (sensitivity comparison) shows a p-value of 0.125, and the McNemar test within non-diseased (specificity comparison) shows a P-value of 0.180. Conclusion: MET-PET is not superior to FDG-PET in terms of identifying recurrent laryngeal cancer.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85056721160&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/30315624

U2 - 10.1111/coa.13242

DO - 10.1111/coa.13242

M3 - Article

VL - 44

SP - 124

EP - 130

JO - Clinical Otolaryngology

JF - Clinical Otolaryngology

SN - 1749-4478

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ER -