FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils

Objective In patients with a history of lymphoma who demonstrate palatine tonsil uptake on posttreatment PET/CT (positron emission tomography/computed tomography), tonsillectomy is often performed to evaluate for lymphoma recurrence. However, predictive clinical and imaging factors for true tonsil r...

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Autores principales:	Jonathan D. West MD, Mary E. Kim, Dorian M. Lapalma MD, Maria Vergara-Lluri MD, Peter Conti MD, Tamara N. Chambers MD, Mark S. Swanson MD
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Otorhinolaryngology RF1-547 Surgery RD1-811
Acceso en línea:	https://doaj.org/article/2afb763836874cf294dbf69dde884c48
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spelling	oai:doaj.org-article:2afb763836874cf294dbf69dde884c482021-11-16T22:33:33ZFDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils2473-974X10.1177/2473974X211059081https://doaj.org/article/2afb763836874cf294dbf69dde884c482021-11-01T00:00:00Zhttps://doi.org/10.1177/2473974X211059081https://doaj.org/toc/2473-974XObjective In patients with a history of lymphoma who demonstrate palatine tonsil uptake on posttreatment PET/CT (positron emission tomography/computed tomography), tonsillectomy is often performed to evaluate for lymphoma recurrence. However, predictive clinical and imaging factors for true tonsil recurrence in this setting are not well established; this will be explored herein. Study Design Retrospective case series. Setting Patients treated at a tertiary medical center from January 2008 to May 2020. Methods Chart review was performed on all patients with a history of treated lymphoma in clinical remission who presented for evaluation of abnormal PET/CT imaging findings and subsequently underwent tonsillectomy. Results Among 15 patients who met inclusion criteria, 14 had benign findings on surgical pathology, yielding a false-positive rate of 93%. The patient with malignancy was identified on biopsy after inconclusive surgical pathology and is the only documented case of recurrence in this specific patient population throughout the literature. The patient presented with B symptoms, irregularly shaped tonsils, increased lymph node activity on PET/CT, and uptrending bilateral tonsil activity but with one of the lowest maximum standardized uptake values of the cohort. The singular distinguishing feature for the patient with recurrent disease was a prior tonsil biopsy suspicious for recurrence, which prompted the otolaryngology referral. Conclusion PET/CT lacks specificity in identifying lymphoma recurrence in the oropharynx. Clinical and radiographic features that were previously considered concerning for recurrence are most likely not indicative of malignancy in this patient population. Our findings call into question whether tonsillectomy should be routinely performed in this patient population.Jonathan D. West MDMary E. KimDorian M. Lapalma MDMaria Vergara-Lluri MDPeter Conti MDTamara N. Chambers MDMark S. Swanson MDSAGE PublishingarticleOtorhinolaryngologyRF1-547SurgeryRD1-811ENOTO Open, Vol 5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Otorhinolaryngology RF1-547 Surgery RD1-811
spellingShingle	Otorhinolaryngology RF1-547 Surgery RD1-811 Jonathan D. West MD Mary E. Kim Dorian M. Lapalma MD Maria Vergara-Lluri MD Peter Conti MD Tamara N. Chambers MD Mark S. Swanson MD FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils
description	Objective In patients with a history of lymphoma who demonstrate palatine tonsil uptake on posttreatment PET/CT (positron emission tomography/computed tomography), tonsillectomy is often performed to evaluate for lymphoma recurrence. However, predictive clinical and imaging factors for true tonsil recurrence in this setting are not well established; this will be explored herein. Study Design Retrospective case series. Setting Patients treated at a tertiary medical center from January 2008 to May 2020. Methods Chart review was performed on all patients with a history of treated lymphoma in clinical remission who presented for evaluation of abnormal PET/CT imaging findings and subsequently underwent tonsillectomy. Results Among 15 patients who met inclusion criteria, 14 had benign findings on surgical pathology, yielding a false-positive rate of 93%. The patient with malignancy was identified on biopsy after inconclusive surgical pathology and is the only documented case of recurrence in this specific patient population throughout the literature. The patient presented with B symptoms, irregularly shaped tonsils, increased lymph node activity on PET/CT, and uptrending bilateral tonsil activity but with one of the lowest maximum standardized uptake values of the cohort. The singular distinguishing feature for the patient with recurrent disease was a prior tonsil biopsy suspicious for recurrence, which prompted the otolaryngology referral. Conclusion PET/CT lacks specificity in identifying lymphoma recurrence in the oropharynx. Clinical and radiographic features that were previously considered concerning for recurrence are most likely not indicative of malignancy in this patient population. Our findings call into question whether tonsillectomy should be routinely performed in this patient population.
format	article
author	Jonathan D. West MD Mary E. Kim Dorian M. Lapalma MD Maria Vergara-Lluri MD Peter Conti MD Tamara N. Chambers MD Mark S. Swanson MD
author_facet	Jonathan D. West MD Mary E. Kim Dorian M. Lapalma MD Maria Vergara-Lluri MD Peter Conti MD Tamara N. Chambers MD Mark S. Swanson MD
author_sort	Jonathan D. West MD
title	FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils
title_short	FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils
title_full	FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils
title_fullStr	FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils
title_full_unstemmed	FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils
title_sort	fdg-pet/ct specificity for the detection of lymphoma recurrence in the tonsils
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/2afb763836874cf294dbf69dde884c48
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FDG-PET/CT Specificity for the Detection of Lymphoma Recurrence in the Tonsils

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