PET/CT findings within the contralateral tonsil following unilateral tonsillectomy

Hirshoren, Nir; Olayos, Elizabeth; Callahan, Jason; Lau, Eddie

doi:10.1002/lary.26023

Cited by 2 publications

(6 citation statements)

References 14 publications

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“…Careful selection of PET-avid tonsils for biopsy may be guided by features such as SUV max , and SUV max ratio. The typical mean SUV max in Waldeyer's ring is demonstrated to be $3.0 to 3.5, 14,19 while those in abnormal tonsils are generally accepted to be $4.6 to 8.0. 20,21 Furthermore, SUV max ratio between tonsils and between the internal carotid artery appears to be another quantitative measure to discriminate physiological uptake from potentially pathological PET avidity in addition to SUV max in isolation.…”

Section: Discussionmentioning

confidence: 99%

“…This demonstrated benign tissue. 14 Conversely, in 77 patients with PET-avid oropharyngeal lesions, including those with a history of head and neck cancer excluding oropharyngeal and SCCUP subgroups, 11 unexpected malignancies were identified, including eight SCC. 21 It may be prudent to interpret these results in context of the broader literature surrounding occult malignancy in tonsils.…”

Section: Discussionmentioning

confidence: 99%

“…Patient and demographic data (e.g., age, sex, living situation, medical comorbidities), clinical signs and symptoms of tonsillar malignancy, 17 PET‐CT characteristics such as symmetry and SUV max , 14 and final histological diagnosis were collected. Follow‐up was censored at the point of final tissue diagnosis, as this is not a therapeutic study.…”

Section: Methodsmentioning

confidence: 99%

“…Only one patient proceeded to tonsillectomy, wherein histopathology demonstrated benign disease. 14 Although the role of biopsy for PET avid lesions in SCCUP workup is well established, 15 the clinical significance of incidental PET avidity in the oropharynx detected on PET scans for other reasons remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…In 308 PET scans performed on 160 patients with known unilateral tonsillar malignancy, only 10 (6.25%) PET‐avid tonsils demonstrated comparatively higher contralateral tonsil uptake. Only one patient proceeded to tonsillectomy, wherein histopathology demonstrated benign disease 14 . Although the role of biopsy for PET avid lesions in SCCUP workup is well established, 15 the clinical significance of incidental PET avidity in the oropharynx detected on PET scans for other reasons remains unclear.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Risk of malignancy in incidental oropharyngeal lesions exhibiting fluorodeoxyglucose uptake which proceed to tissue biopsy

Key,

Chia,

Magarey

et al. 2023

ANZ Journal of Surgery

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BackgroundUtilization of positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose is increasing in use for a variety of indications, including surveillance of cancer patients. There is a paucity of evidence pertaining to the significance of incidental PET‐avid oropharyngeal lesions. This study aims to examine the clinical and radiological features of these incidental oropharyngeal lesions in patients undergoing PET for indications other than head and neck cancer.MethodsRetrospective cohort study of three Australian tertiary hospitals, from 2015 to 2021, on adult patients undergoing biopsy of incidental PET‐avid oropharyngeal lesions. Primary outcome of interest was the incidence of malignancy. Patients with a previous history of, or undergoing investigations for, head and neck cancer were excluded.ResultsThirty‐one patients were included, wherein 21 patients had tonsillar uptake, and 13 patients had base of tongue uptake. Tonsillar disease was mostly asymmetrical (n = 15/21), bilateral (n = 11/21), and had median SUVmax 9.35 (n = 12, IQR 7.4–11.15). Base of tongue was mostly asymmetrical (n = 7/13, 54%), bilateral (n = 8/13, 62%), and had median SUVmax 8.2 (n = 10, IQR 6.9–12.65). Seven patients had malignancy confirmed on tissue biopsy: five biopsies confirmed the tissue diagnosis of suspected lymphoma, and two incidental findings of unexpected malignancies: one p16 positive tonsillar squamous cell carcinoma, and one metastatic breast cancer.ConclusionIn 31 patients undergoing tissue biopsy for incidental PET‐avid oropharyngeal lesions, there were two unexpected malignancies. Our study results indicate that although unexpected malignancies are uncommon, a malignant diagnosis cannot be excluded from clinical features alone.

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