Dataset Information

Incidental FDG-Avid Focuses in Palatine Tonsils on PET/CT.

ABSTRACT:

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 (SUV_max ) 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 SUV_max cutoff (≥9: sensitivity 100%; specificity 53%) was superior to SUV_max 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 SUV_max ≥ 9.0, ratio ≥ 1.5, or symptoms or findings suggesting malignancy.

Level of evidence

3 Laryngoscope, 132:2370-2378, 2022.

SUBMITTER: Reinholdt KB

PROVIDER: S-EPMC9790499 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Incidental FDG-Avid Focuses in Palatine Tonsils on PET/CT.

Reinholdt Kasper Basse KB Dias André Henrique AH Hoff Camilla Molich CM Gormsen Lars Christian LC Klug Tejs Ehlers TE

The Laryngoscope 20220228 12

<h4>Objectives</h4>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 (SUV<sub>max</sub> ) to discriminate between benign and malignant lesions.<h4>Methods</h4>All patients who were tonsillectomized at our institution because of IFT from October 2011 to December 2020 were included. Patients undergoing ...[more]

PMID: 35226376

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Project description:ObjectivesTo describe the findings of incidental asymptomatic COVID-19 infection on FDG PET-CT using a case-control design.MethodsIncidental pulmonary findings suspicious of asymptomatic COVID-19 infection on FDG PET-CT were classified as a confirmed (positive RT-PCR test) or suspected case (no/negative RT-PCR test). Control cases were identified using a 4:1 control:case ratio. Pulmonary findings were re-categorised by two reporters using the BSTI classification. SUV metrics in ground glass opacification (GGO)/consolidation (where present), background lung, intrathoracic nodes, liver, spleen and bone marrow were measured.Results7/9 confirmed and 11/15 suspected cases (COVID-19 group) were re-categorised as BSTI 1 (classic/probable COVID-19) or BSTI 2 (indeterminate COVID-19); 0/96 control cases were categorised as BSTI 1. Agreement between two reporters using the BSTI classification was almost perfect (weighted κ = 0.94). SUVmax GGO/consolidation (5.1 vs 2.2; p < 0.0001) and target-to-background ratio, normalised to liver SUVmean (2.4 vs 1.0; p < 0.0001) were higher in the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases. SUVmax GGO/consolidation discriminated between the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases with high accuracy (AUC = 0.93). SUV metrics were higher (p < 0.05) in the COVID-19 group vs control cases in the lungs, intrathoracic nodes and spleen.ConclusionAsymptomatic COVID-19 infection on FDG PET-CT is characterised by bilateral areas of FDG avid (intensity > x2 liver SUVmean) GGO/consolidation and can be identified with high interobserver agreement using the BSTI classification. There is generalised background inflammation within the lungs, intrathoracic nodes and spleen.Advances in knowledgeIncidental asymptomatic COVID-19 infection on FDG PET-CT, characterised by bilateral areas of ground glass opacification and consolidation, can be identified with high reproducibility using the BSTI classification. The intensity of associated FDG uptake (>x2 liver SUVmean) provides high discriminative ability in differentiating such cases from pulmonary findings in a non-COVID-19 pattern. Asymptomatic COVID-19 infection causes a generalised background inflammation within the mid-lower zones of the lungs, hilar and central mediastinal nodal stations, and spleen on FDG PET-CT.

Dataset Information

Incidental FDG-Avid Focuses in Palatine Tonsils on PET/CT.

Objectives

Methods

Results

Conclusion

Level of evidence

Publications

Incidental FDG-Avid Focuses in Palatine Tonsils on PET/CT.

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