Positron emission tomography evaluation of sinonasal inverted papilloma and related conditions: a prospective clinical study

Abstract

Objectives: This study aims to determine whether there is a difference between inverted papilloma (IP) and nasal polyp, and squamous cell carcinoma (SCC) with regard to fluorodeoxyglucose uptake. Patients and Methods:Between September 2007 and May 2014, positron emission tomography computed tomography (PET/CT) images of 27 patients (20 males, 7 females; mean age 53.4 years; range 18 to 74 years), with unilateral polyposis diagnosed on examination and tomographic scans of paranasal sinus were obtained. Nasal polyps in eight of the patients (group 1), IP in 10 patients (group 2), and SCC in nine patients (group 3) were found. The data were compared with Kruskal-Wallis and Mann-Whitney U tests. Results:The mean maximum standardized uptake (SUVmax) values were found to be 2.9 in the group 1; 7.8 in the group 2, and 17.8 in the group 3. There was significant difference in the SUVmax values between the group 1 and the group 2 (p=0.016), the group 1 and the group 3 (p=0.001), and the group 2 and the group 3 (p=0.01). Conclusion:According to the results of this study, PET/CT scan in the patients with unilateral polyposis is invaluable to distinguish nasal polyp from IP and SCC. It is also useful to recognize the distinctions between IP and SCC. In our study of 27 patients, a SUVmax of 6 or higher ruled out the presence of nasal polyp [95% CI (5.93 to 13.39), specificity 100%] might also be clinically useful.

Advances in recurrence and malignant transformation of sinonasal inverted papillomas

“…Allegra et al (42) analyzed 12 patients (7 with primary diagnosis of SIP and 5 with suspected recurrence of SIP) using 18FDG-PET/CT for the diagnosis of SIP with a sensitivity and specificity rate of 100% (42). Similarly, a 2015 study containing 27 patients demonstrated that 18FDG-PET/CT is able to distinguish polyposis, SIP and SCC by distinct standardized uptake value (SUV max ) values (45). Shojaku et al (46) confirmed that higher SIP SUV max values may indicate the probability of an associated malignancy, even when preoperative biopsy indicates a benign papilloma.…”

Different characteristics of a single sinonasal inverted papilloma from sequential PET-CT

“…This is the first report of a serial and significant change in SUV from PET CT in the same lesion and in the same patient. According to the previous literature, it was possible to distinguish IP and SCC from an inflammatory polyp using PET-CT. [3] However, it was difficult to distinguish IP from an inflammatory polyp or SCC using only the SUV value.…”

“…[2] Histologic examination is the only definite diagnosis of IP. Positron emission tomography (PET CT) can be a useful diagnostic tool in some studies [3,4] ; however, some authors have pointed out that PET cannot distinguish malignant tumors from IP. [5]…”

Clinical evidence based review and systematic scientific review in the identification of malignant transformation of inverted papilloma

“…PET-CT studies have shown that IP patients have higher SUV max than non IP patients, and IP-SCC patients have higher SUVs than IP patients (Table 8) [37]. However, Joen et al found that SUVs for IPs can at times be high leading to a false diagnosis of IP-SCC [35].…”