FDG uptake in cervical lymph nodes in children without head and neck cancer

Abstract

Background

Reactive cervical lymphadenopathy is common in children and may demonstrate increased ¹⁸F–fluoro-deoxyglucose (¹⁸F–FDG) uptake on positron emission tomography/computed tomography (PET/CT).

Objective

We sought to evaluate the frequency and significance of ¹⁸F–FDG uptake by neck lymph nodes in children with no history of head and neck cancer.

Materials and methods

The charts of 244 patients (114 female, mean age: 10.4 years) with a variety of tumors such as lymphoma and post-transplant lymphoproliferative diseases (PTLD), but no head and neck cancers, who had undergone ¹⁸F–FDG PET/CT were reviewed retrospectively. Using the maximum standardized uptake value (SUVmax), increased ¹⁸F–FDG uptake by neck lymph nodes was recorded and compared with the final diagnosis based on follow-up studies or biopsy results.

Results

Neck lymph node uptake was identified in 70/244 (28.6%) of the patients. In 38 patients, the lymph nodes were benign. In eight patients, the lymph nodes were malignant (seven PTLD and one lymphoma). In 24 patients, we were not able to confirm the final diagnosis. Seven out of the eight malignant lymph nodes were positive for PTLD. The mean SUVmax was significantly higher in malignant lesions (4.2) compared with benign lesions (2.1) (P = 0.00049).

Conclusion

¹⁸F–FDG uptake in neck lymph nodes is common in children and is frequently due to reactive lymph nodes, especially when the SUVmax is <3.2. The frequency of malignant cervical lymph nodes is higher in PTLD patients compared with other groups.

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