Clinically Node-Negative and Radiology Clinical Trial
Official title:
Predictive Value of PET CT in the Histologic Lymph Node Status of Patients With Squamous Cell Carcinoma of the Oral N0 Clinical and Radiological Cavity.
Squamous cell carcinoma of the VADS represents the majority of cancers in ENT. Metastatic
lymph node involvement is an important prognostic factor. In N0 patients clinically and
scanographically, the prevalence of cervical lymph node metastasis remains important. Only
the anatomopathological analysis of cervical lymph node dissection confirms the presence of a
micro-metastasis. However, new criteria of interpretation in nuclear medicine seem promising
in the detection of lymph node lesions not detectable in traditional imaging.
The main objective of this study is to study the positive predictive value (PPV) of CT scans
in the anatomo-pathological analysis of N0 clinical and radiological or N + unilateral neck
ganglia in patients with squamous cell carcinoma of the oral cavity.
The main objective is to study the positive predictive value of PET-CT in the identification
of infra-clinical lymph node lesions for cancers of the oral cavity classified N0 or N +
unilateral
Patients are admitted to ORL or maxillofacial consultation with initial clinical examination
according to current recommendations (tumor evaluation, cervical palpation, locoregional
examination).
A dated and signed diagram of the lesion and ganglionic areas will be made during this
consultation.
A biopsy for histopathological examination of the lesion will be necessary to confirm the
diagnosis of squamous cell carcinoma with P16 analysis. It will be performed during the
consultation under local anesthesia if the lesion is accessible or under general anesthesia
during panendoscopy.
All patients will benefit from an assessment of locoregional extension by CT cervicofacial
and thoracic injected (in order to look for possible pulmonary metastases or suspicious
mediastinal lymphadenopathies) as requested in the oncological recommendations and PET-CT. As
part of the extension assessment, a panendoscopy or bronchial fibroscopy and
gastro-oesophageal failure will be performed if risk factors ethanolotagagic are present.
If the lesion is not accessible for a biopsy during the inclusion visit, the patient is
summoned for a panendoscopy. It is an examination under general anesthesia to make a biopsy
of the primary tumor and to search for the absence of synchronous localization. In current
practice, this examination requires overnight hospitalization.
The patient will be reviewed by the ORL or maxillofacial surgeon in consultation after
receiving the anatomopathological findings of the lesion and the entire extension assessment
(CT cervico-thoracic injected and PET-CT).
On CT PET, an analysis with additional interpretation criteria will be performed (SUVmax, SUV
peak, MTG) on the primary tumor and on the invaded lymph nodes. A ganglion is considered
invaded when its SUV is suppressed at 30% of the SUV of the original lesion.
The patient's file will have been previously presented in a Multidisciplinary Concertation
Meeting, whose treatment will consist of a surgical excision of the primary lesion and a
lymph node dissection.
The patient will be seen again in consultation at 10 days of his intervention as part of the
follow-up postoperative in order to be able to receive all the anatomopathologic results of
the operative specimen and ganglion dissection. The patient's record will have been
represented in CPR in order to decide whether or not to have an adjuvant treatment based on
the anatomopathological characters (capsular rupture, number of ganglions invaded,
peri-nervous sheath).
;