A correlation between comprehensive neck dissection and increased uptake around the sternoclavicular joint on post-operative 18F-FDG PET/CT

Korean Journal of Head & Neck Oncology 2018;34(1):21-27.
Published online May 30, 2018.

So Won Oh;Doh Young Lee;Bo Hae Kim;Kwang Hyun Kim;Yu Kyeong Kim;Young Ho Jung

경부절제술과 술후 시행된 PET/CT상의 흉쇄관절 섭취 증가의 상관관계 분석

오소원;이도영;김보해;김광현;김유경;정영호

Abstract

Background/Objectives
This study aimed to evaluate the changes of uptake around the sternoclavicular joint (SCJ) according to 18F-FDG PET images in patients with head and neck cancer who underwent neck dissection.
Materials & Methods
Retrospectively, the medical records of patients who received selective or comprehensive neck dissection were reviewed. Preoperative and 1-year postoperative 18F-FDG PET images, if available, were analyzed by nuclear medicine physicians in both qualitative and quantitative manners.Correlation between the changes of uptake around SCJ and perioperative data were statistically analyzed.
Results
Thirty-seven patients satisfying the inclusion criteria were enrolled. Seven patients with increased uptake around SCJ on 1-year postoperative 18F-FDG PET showed a correlation with radical or comprehensive neck dissection, accessory nerve sacrifice, and high postoperative SUVmax. When 20 patients with increased uptake around SCJ according to quantitative measurement were compared with other patients without increased uptake, no parameter was significantly different, except postoperative SUVmax. Bivariate logistic regression analysis revealed that the clinical symptom (shoulder or sternal pain) was significantly correlated with the extent of neck dissection (OR 0.227, CI 0.053-0.966, p=0.045) and spinal accessory nerve sacrifice (OR 13.500, CI 1.189-153.331, p=0.036).
Conclusions
Increased uptake around SCJ on 1-year postoperative 18 F-FDG PET was correlated with either the radical or comprehensive procedure, as well as with accessory nerve sacrifice. This suggests that subjective analysis of 18F-FDG PET can be used to detect subclinical shoulder instability.

Key Words: Sternoclavicular joint, Neck dissection, Accessory nerve, Positron-Emission Tomography, Head and neck neoplasm