PET/CT Alone Should Not Be Used to Exclude Tonsillar Cancer

Comment: Increased and asymmetric PET/CT FDG uptake in the tonsils is a frequent reason for referral to otolaryngology. However, it is unclear what uptake threshold should prompt biopsy. Certainly, we don’t want to miss primary tonsillar cancer; we also don’t want to perform unnecessary procedures. This small study showed that an SUVmax ratio between tonsils >1.6 (62% sensitive, 100% specific) is highly suspicious and warrants biopsy. They also note that malignant tonsils can have normal FDG uptake. Thus, PET/CT alone should not be used to exclude
cancer. —Jennifer Villwock, MD

What is the maximum standardized uptake value (SUVmax) ratio between tonsils in patients with and without tonsillar carcinoma to determine useful diagnostic thresholds?

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