Does PET/CT improve patient management after curative-intent radiotherapy (RT) for head & neck squamous cell carcinoma (HNSCC)?
Bibliographic record
Abstract
509 Objectives To determine the value of adding PET/CT to clinical assessment after curative-intent RT in patients with HNSCC. Methods Patients with HNSCC receiving a post-RT PET/CT from 2005-2010 were retrospectively identified. RT was followed by clinical exam and at least one PET/CT 60-180 days after RT-end. The clinical exam immediately prior to the date of the PET/CT was scored as: i) disease free or ii) suspicious/definite for HNSCC. PET/CT scans were scored as: i) disease free, ii) equivocal, or iii) suspicious/definite for HNSCC. Final analysis was conducted in two ways: an equivocal PET/CT was considered either (1) positive or (2) negative. Sensitivity, specificity, PPV, NPV, accuracy, false negative (FN), and false positive (FP) rates of PET/CT were determined for each analysis. Referring physicians were prospectively sent surveys 7-10 days after a patient9s PET/CT to assess the percent change in patient management from PET/CT results. Results 352 patients met eligibility. PET/CT was performed a median of 14 weeks after RT. Median follow-up after RT was 30 months. Sensitivity, specificity, PPV and NPV were 85%, 80%, 56%, 95%, for Analysis 1, and 75%, 92%, 74%, and 93% for Analysis 2, respectively. Overall accuracy of PET/CT was 81% in Analysis 1 and 88% in Analysis 2. The FN and FP rates were 3.4% and 15.3% in Analysis 1, and 5.7% and 6% in Analysis 2, respectively. 76% of ordering physicians felt PET/CT led to a change in their intended patient management. Conclusions A negative PET/CT ~14 weeks after RT reliably predicts disease absence. Patients with negative clinical exam and negative PET/CT may be offered less frequent follow-up than usual. The PPV of PET/CT is modest, requiring confirmation prior to radical surgery. Patients with an equivocal PET/CT should be followed with close clinical exam and imaging to reduce the possible harm from FNs. Physicians found PET/CT valuable in decision-making. Thus, PET/CT should be part of the post-treatment clinical algorithm for patients with HNSCC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".