Incidental FDG‐Avid Focuses in Palatine Tonsils on PET/CT

Objectives The management of incidental findings of FDG‐avid tonsils on PET/CT (IFT) is unclear. We aimed to explore the prevalence of malignancy in IFT, identify risk factors for malignancy, and calculate optimal cutoffs of maximum standardized uptake values (SUVmax) to discriminate between benign...

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Bibliographic Details
Published in:The Laryngoscope 2022-12, Vol.132 (12), p.2370-2378
Main Authors: Reinholdt, Kasper Basse, Dias, André Henrique, Hoff, Camilla Molich, Gormsen, Lars Christian, Klug, Tejs Ehlers
Format: Article
Language:English
Subjects:
Alcohol abuse
cancer
FDG‐PET/CT
Fluorodeoxyglucose F18
Head and Neck
Humans
incidental
Incidental Findings
Laryngoscopy
malignancy
Original Report
Palatine Tonsil - diagnostic imaging
Positron Emission Tomography Computed Tomography
Positron-Emission Tomography
Radiopharmaceuticals
Throat surgery
tonsil
Tonsillectomy
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Summary:Objectives The management of incidental findings of FDG‐avid tonsils on PET/CT (IFT) is unclear. We aimed to explore the prevalence of malignancy in IFT, identify risk factors for malignancy, and calculate optimal cutoffs of maximum standardized uptake values (SUVmax) to discriminate between benign and malignant lesions. Methods All patients who were tonsillectomized at our institution because of IFT from October 2011 to December 2020 were included. Patients undergoing PET/CT due to suspected tonsillar disease or cancer of unknown primary were excluded. Results In total, 77 patients were included, of which 11 (14%) of them had IFT malignancy. Dysphagia (p = 0.019) and alcohol abuse (p = 0.035) were associated with malignancy. Absolute SUVmax cutoff (≥9: sensitivity 100%; specificity 53%) was superior to SUVmax side‐to‐side ratio (≥1.5: sensitivity 64%; specificity 70%) to discriminate between benign and malignant lesions. Conclusion We recommend tonsillectomy for patients with IFT displaying SUVmax ≥ 9.0, ratio ≥ 1.5, or symptoms or findings suggesting malignancy. Level of Evidence 3 Laryngoscope, 132:2370–2378, 2022
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.30081