http://jnm.snmjournals.org/content/52/1/81.full

this rescuers for second article  

__________

 for first essay using the neck file and follow the direction 

for second essay using the web site and follow the direction 

RESEARCH Open Access

FDG-PET staging and importance of lymph node
SUV in head and neck cancer
Gregory J Kubicek1,2,3*, Collin Champ1, Shannon Fogh1,4, Fen Wang2, Eashwer Reddy2, Charles Intenzo1,
Reginald W Dusing2, Mitchell Machtay1,5

Abstract

Objectives: The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of
head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard
workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and
providing prognostic information for HNC.

Methods: Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas
Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET
scans were performed in patients who went on to receive radiotherapy.

Results: The median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly
identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had
higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p < 0.0007). Maximum SUV for the primary tumor > 8.0 was
predictive of worse overall survival (p < 0.045), while the SUV of the lymph nodes was predictive for distant
recurrence at one year–with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p < 0.05).

Conclusions: FDG-PET staging in head and neck cancer has good positive and negative predictive values in
determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the
first report to find that the SUV of a lymph node is predictive for ECE and also for distant recurrence.

Introduction
Approximately 47,500 new cases of head and neck can-
cer (HNC) are diagnosed annually in the United States
[1], the cure rates for HNC, especially in advanced dis-
ease, remains poor [2]. Because of this there have been
efforts to improve outcomes through the use of targeted
agents [3], new radiation techniques such as intensity
modulated radiation therapy (IMRT) and image guided
radiation therapy (IGRT), as well as new types of diag-
nostic imaging. Scanning utilizing FDG has become
standard of care for many malignant neoplasms [4] for
its ability to more accurately stage tumors, and thus
alter therapeutic decision making, compared to conven-
tional imaging modalities such as computed tomography
(CT) and magnetic resonance imaging (MRI).
The use of FDG-PET scanning in head and neck can-

cer is more controversial. NCCN guidelines do not

include PET scans as part of routine staging, and many
institutions use MRI or ultrasound guided biopsies
rather than PET scans. The Radiation Therapy Oncology
Group (RTOG) utilizes the clinical exam, chest x-ray,
and pre-treatment CT scan as t

PET Paper

Due Date: 4 hours

The professional reading assignment requires one PET article from a recent (2012, or 2013, 2014, 2015 or 2016 publication) acceptable professional journal to be chosen, read, and reviewed by the student. Articles older than 2009 will not be accepted! Professional journals include The Journal of Nuclear Medicine, The Journal of Nuclear Medicine Technology, Seminars in Nuclear Medicine, and Clinical Nuclear Medicine. (The RT Image, Radiology Today, and the Advance are news magazines and are not acceptable sources of articles for this assignment.) The article chosen and submitted must be a peer reviewed article (authors listed, date of submission, date of acceptance, etc). The article must be related to PET. A copy of the article MUST be included or half credit will be deducted. Students may not use an article another student has previously submitted (check with instructor if needed).

At a minimum, the typed assignment should address why that specific article was chosen, the purpose of the article, an outline of the key points covered in the article, a summary of the results or conclusions of the article, and a response by the student as to the value or potential value the information in the article has on the field of nuclear medicine technology and relate it to what you have learned as a Nuclear Medicine student. A cover page as well as a brief reference page MUST be included or points will be deducted.

This review should be typed and each major section (why, purpose, key points, summary/conclusions, response) indicated as an APA heading. This makes it easier to follow and allows me to grade them more quickly. Failure to follow these instructions will result in a 10% point deduction. Each section should contain at a minimum of one full paragraph of text. One sentence does not constitute a paragraph. My discretion will be used in whether or not this requirement has been met. You may have more than one paragraph in each section as needed, especially when reviewing the key points.

In your response, please give an honest assessment. Please explain the importance of the article or lack of importance relating to PET based on what you have learned.

The assignment should be a minimum of 3 typed pages (double spaced), but no more than 5 typed pages. This requirement does not include the cover or reference page. Assignments must be submitted through the blackboard link. Papers exceeding 5 pages (or less than 3) will be penalized. No credit will be awarded if the assignment is late.


PET Paper

Due Date: 4 hours

The professional reading assignment requires one PET article from a recent (2012, or 2013, 2014, 2015 or 2016 publication) acceptable professional journal to be chosen, read, and reviewed by the student. Articles older than 2009 will not be accepted! Professional journals include The Journal of Nuclear Medicine, The Journal of Nuclear Medicine Technology, Seminars in Nuclear Medicine, and Clinical Nuclear Medicine. (The RT Image, Radiology Today, and the Advance are news magazines and are not acceptable sources of articles for this assignment.) The article chosen and submitted must be a peer reviewed article (authors listed, date of submission, date of acceptance, etc). The article must be related to PET. A copy of the article MUST be included or half credit will be deducted. Students may not use an article another student has previously submitted (check with instructor if needed).

At a minimum, the typed assignment should address why that specific article was chosen, the purpose of the article, an outline of the key points covered in the article, a summary of the results or conclusions of the article, and a response by the student as to the value or potential value the information in the article has on the field of nuclear medicine technology and relate it to what you have learned as a Nuclear Medicine student. A cover page as well as a brief reference page MUST be included or points will be deducted.

This review should be typed and each major section (why, purpose, key points, summary/conclusions, response) indicated as an APA heading. This makes it easier to follow and allows me to grade them more quickly. Failure to follow these instructions will result in a 10% point deduction. Each section should contain at a minimum of one full paragraph of text. One sentence does not constitute a paragraph. My discretion will be used in whether or not this requirement has been met. You may have more than one paragraph in each section as needed, especially when reviewing the key points.

In your response, please give an honest assessment. Please explain the importance of the article or lack of importance relating to PET based on what you have learned.

The assignment should be a minimum of 3 typed pages (double spaced), but no more than 5 typed pages. This requirement does not include the cover or reference page. Assignments must be submitted through the blackboard link. Papers exceeding 5 pages (or less than 3) will be penalized. No credit will be awarded if the assignment is late.