What is the efficacy of combined positron emission tomography-computed tomography (PET-CT) in identifying salivary gland malignancies, and what is its role in the management of these patients?
Explore this issue:April 2010
Background: In early studies, PET information improved the sensitivity of CT in detecting primary salivary tumors, cervical metastases and distant metastases, but the small number of patients and the evolution to combined PET-CT scanning suggest a re-evaluation of the role of these scans.
Study Design: Chart review of 55 patients between January 2000 and October 2008
Setting: University of Pittsburgh
Synopsis: A total of 135 PET-CT scans (mean of 2.5 per patient) were reviewed and correlated with clinicopathological information. PET-CT was used primarily in the setting of surveillance for recurrent or distant disease but also for restaging patients with known recurrence and in initial staging and surgical planning. The sensitivity, specificity and positive and negative predictive values for PET-CT were analyzed. Overall, PET-CT demonstrated a sensitivity of 74.4 percent, specificity of 100 percent, positive predictive value of 100 percent and a negative predictive value of 61.5 percent. There was no significant difference in sensitivity between high-grade tumors and low-intermediate-grade tumors. PET-CT altered or confirmed management in 47.3 percent of the patients.
Bottom Line: PET-CT is effective in the evaluation of salivary cancers and is particularly useful in initial staging and for surgical and radiation therapy planning. There appears to be less benefit in long-term surveillance and detecting distant metastasis where CT with contrast alone is likely to be sufficient.
Citation: Razfar A, Heron DE, Branstetter BF IV, et al. Positron emission tomography-computed tomography adds to the management of salivary gland malignancies. Laryngoscope. 2010;120(4):734-738.
—Reviewed by Sue Pondrom