Squamous cell carcinoma of the palatine tonsils: FDG standardized uptake value ratio as a biomarker to differentiate tonsillar carcinoma from physiologic uptake

Jessica M. Davison, Al Ozonoff, Heather M. Imsande, Gregory A. Grillone, Rathan M. Subramaniam

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

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 SUV max 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 cutoffratio 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.

Original languageEnglish (US)
Pages (from-to)578-585
Number of pages8
JournalRadiology
Volume255
Issue number2
DOIs
StatePublished - May 1 2010

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Palatine Tonsil
Squamous Cell Carcinoma
Biomarkers
Carcinoma
Fluorodeoxyglucose F18
Tonsillar Neoplasms
Health Insurance Portability and Accountability Act
Research Ethics Committees
Informed Consent
ROC Curve
Area Under Curve
Neck
Retrospective Studies
Head
Confidence Intervals
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Squamous cell carcinoma of the palatine tonsils : FDG standardized uptake value ratio as a biomarker to differentiate tonsillar carcinoma from physiologic uptake. / Davison, Jessica M.; Ozonoff, Al; Imsande, Heather M.; Grillone, Gregory A.; Subramaniam, Rathan M.

In: Radiology, Vol. 255, No. 2, 01.05.2010, p. 578-585.

Research output: Contribution to journalArticle

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title = "Squamous cell carcinoma of the palatine tonsils: FDG standardized uptake value ratio as a biomarker to differentiate tonsillar carcinoma from physiologic uptake",
abstract = "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 SUV max 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 cutoffratio 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.",
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T2 - FDG standardized uptake value ratio as a biomarker to differentiate tonsillar carcinoma from physiologic uptake

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AU - Ozonoff, Al

AU - Imsande, Heather M.

AU - Grillone, Gregory A.

AU - Subramaniam, Rathan M.

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N2 - 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 SUV max 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 cutoffratio 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.

AB - 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 SUV max 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 cutoffratio 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.

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