Nabili Vishad, Zaia Brita, Blackwell Keith E, Head Christian S, Grabski Karsten, Sercarz Joel A
Division of Head and Neck Surgery-Otolaryngology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA 90095, USA.
Am J Otolaryngol. 2007 May-Jun;28(3):153-7. doi: 10.1016/j.amjoto.2006.08.001.
The aim of the study was to determine the sensitivity of preoperative positron emission tomography (PET) scans in the detection of primary tumors of the tonsils.
We conducted a retrospective review of 46 patients treated at a university medical center for occult tonsillar cancer during the years 2002 to 2004. We identified patients who underwent a preoperative PET scan to locate an unknown primary tumor. Fusion computed tomography with PET (PET/CT) was used to further delineate anatomic localization to the tonsil area. A positive PET/CT scan was defined as asymmetric increased tracer uptake in the tonsil and/or tonsillar fossa ipsilateral to the tonsillar cancer site when compared with the contralateral site. A negative PET/CT scan was defined as equivocal symmetric tracer uptake bilaterally.
Of the 46 patients, 6 (13.0%) had pretreatment PET scans. Of these 6 patients, 16.7% (n = 1) had positive PET, 66.7% (n = 4) had negative PET, and 16.7% (n = 1) demonstrated increased tracer uptake in tonsils bilaterally greater on the side contralateral to the cancer. In this group, PET scans had a sensitivity of 0.167 and false-negative ratio of 0.667 for tonsillar cancer detection.
Although the patient population in this study is small (n = 6), the findings suggest that PET/ CT scans may offer a low sensitivity in detection of primary tonsillar cancers. However, PET/CT scans still have a significant role in the detection of other unknown primary head and neck tumors. Technical reasons for this finding are discussed.
