Abstract
PurposeFluorodeoxyglucose (FDG) positron emission tomography (PET) is increasingly used to diagnose and stage malignancy. The aim of this article is to investigate the significance of incidental FDG uptake in the Waldeyer’s ring and to assess its value in predicting clinically occult oropharyngeal malignancy.MethodsAll FDG-PET/CT scans performed in Imperial College NHS Foundation Trust, UK between January 2012 and November 2018 were included. Patients with known or suspected oropharyngeal malignancy or lymphoma were excluded. Minimum follow-up was 12 months.ResultsA total of 724 scans revealed oropharyngeal uptake of FDG. Of these, 102 were included in the study. Most patients (62.1%) were scanned as part of staging for other malignancies. Oropharyngeal FDG uptake was asymmetrical in 57.3% of the cases. Uptake was more common in the tonsils (56.3%), followed by the tongue base (31.1%) and both sites (12.6%). In 41.7% of reports, appearance was described as likely physiological; however, 52.4% of reports advised direct visualisation, clinical correlation or ENT opinion. Only 24.3% (25/102) of patients were referred and seen by ENT, 14.6% (15/102) of which had an interval PET scan and 8.7% (9/102) proceeded to tissue diagnosis. There was one oropharyngeal cancer identified and one unexpected metastasis from esophageal cancer.ConclusionIncidental uptake on PET/CT in the oropharynx is common. However, malignancy is rare (1.9%) and, when present, is associated with high SUVmax and asymmetrical uptake. Imaging results must be correlated clinically. These patients should be seen by an ENT specialist yet most may not require further investigations.
Highlights
Head and neck malignancy represents 3% of all newly diagnosed cancers in the UK, with approximately 11 945 cases diagnosed every year [1]
Included patients were older than 18 years and had unexpected or incidental FDG uptake in the oropharynx during a positron emission tomography (PET)/computed tomography (CT) scan
A further 135 patients were excluded for having or being suspected of having a haematological malignancy, 45 patients were excluded as they did not have any FDG uptake in the lingual or palatine tonsils and seven patients were excluded as there was full clinical notes were not available
Summary
Head and neck malignancy represents 3% of all newly diagnosed cancers in the UK, with approximately 11 945 cases diagnosed every year [1]. Despite substantial advancements in surgical techniques and pharmacological therapies over the past decades, the prognosis of most head and neck cancers remains poor This is partly because of advanced disease at the time of presentation in over 60% of patients. Synchronous and metachronous malignancies are common due to the phenomenon of ‘field cancerisation’ in the upper aerodigestive tract and the effect of tobacco smoking and alcohol consumption [2,3,4]. These findings are supported by a recent meta-analysis showing that patients with hypopharyngeal and oropharyngeal malignancies are at the highest risk of concurrent malignancies [5]
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