الفهرس 
Title : Role of F18 FDG PET/CT in initial staging of head and neck squamous cell carcinoma /
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Abstract
Objectives: To assess the role of PET/CT in the initial staging of head and neck squamous cell carcinoma and its role in changing the management compared to other conventional methods. Methods: A prospective study of 31 patients (21 male and 10 female) mean age 49.3 years with histologically confirmed squamous cell carcinoma of the head and neck (nasopharynx was the commonest cancer in 15 patients (48.4%), poorly differentiated grade represented 64.5% of all tumors in 20 patients. The initial staging was achieved according to a routine physical examination, endoscopy, CT, U/S, MRI, then PET/CT was performed in a time interval less than 30 days. The findings of PET/CT were compared with those of the other conventional method. Correlation analysis between SUVmax of the primary tumor with tumor size, T staging and tumor grade was done as well as between SUVmax of the lymph node with lymph node size, N staging and tumor grade. Results: No significant difference between conventional methods and PET/CT in both T and M staging (p=0.8 and 0.6, respectively). While N staging showed a significant difference (p=0.034).The overall change in TNM staging by PET/CT in relation to conventional methods was encountered in 15/31 patients (48.4%). PET/CT changed; T staging in 3patients (9.6%), up staging in 2 patients and down staging in one patient. PET/CT upstaged all 13/31 patients in N staging (41.9%). PET/CT changed; M staging in 3/31 (9.6%) patients, up staging in 2 and down staging in one patient. PET/CT changed the intent of treatment from curative to palliative treatment in a 1 patient with nasopharyngeal carcinoma having multiple bone metastases. PET/CT results caused radiotherapy modification in 21/31 patients (67.7%). PET/CT could detect intra-parotid nodule in 4 patients, only one of them was detected by conventional CT so additional radiation was added to the parotid in the treatment