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ORIGINAL RESEARCH

Squamous Cell Carcinoma of the Palatine Tonsils: FDG Standardized Uptake Value Ratio as a Biomarker to Differentiate Tonsillar Carcinoma from Physiologic Uptake

Published Online:Apr 8 2010https://doi.org/10.1148/radiol.10091479

Abstract

The maximum standardized uptake value ratio is an accurate imaging biomarker for differentiating tonsillar squamous cell carcinoma from physiologic uptake in the tonsils.

Purpose

To quantify fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake in the palatine tonsils to identify a sensitive and specific metric for distinguishing physiologic asymmetric uptake from squamous cell carcinoma (SCC).

Materials and Methods

This HIPAA-compliant retrospective study was approved by institutional review board. Informed consent requirements were waived. Twenty-six patients (seven female, 19 male; mean age, 53.46 years ± 10.45 [standard deviation]) with tonsillar SCC were included. Twenty-six patients (seven female, 19 male; mean age, 61.77 years ± 10.12) with head and neck carcinomas not involving the tonsils were included as control subjects. Tonsil standardized uptake values (SUVs) were measured bilaterally in each group. Independent-samples t test was used to compare mean SUVs, and Pearson correlation was used to evaluate association of FDG uptake between tonsils within control subjects.

Results

The mean maximum SUV (SUVmax) of tonsil tumors was 9.36 ± 4.54, which was significantly higher than that of contralateral cancer-free tonsils (2.54 ± 0.88; P < .0001) and tonsils in control subjects (2.98 ± 1.08; P < .0001). In patients with tonsillar cancer, the mean difference in SUVmax between tonsils was 10.43 ± 7.07, which was significantly greater than that in control subjects (0.62 ± 0.54; P < .0001). The mean SUVmax ratio between tonsils in patients with carcinoma was 3.79 ± 1.69, which was threefold higher than in control subjects (1.18 ± 0.13; P < .0001). For receiver operating characteristic analysis using SUVmax ratio to differentiate benign uptake from SCC, the area under the curve was 1.00 (95% confidence interval: 1.00, 1.00). A cutoff ratio of 1.48 had 100% sensitivity and specificity.

Conclusion

The SUVmax ratio represents an accurate imaging biomarker for differentiating tonsillar SCC from physiologic 18F-FDG uptake.

© RSNA, 2010

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Article History

Received August 24, 2009; revision requested October 6; revision received October 16; accepted October 27; final version accepted November 2.
Published online: Apr 8 2010
Published in print: May 2010