Diagnostic utility of positron emission tomography-computed tomography for predicting malignancy in cystic neck masses in adults.
OBJECTIVE
Combined positron emission tomography and computed tomography (PET-CT) is used for the diagnostic evaluation and staging of squamous cell carcinoma of the head and neck (SCCHN). By superimposing anatomic localization of CT with the physiologic data of PET, occult primary and metastatic neoplasms might be identified. Because the diagnostic algorithm for cystic neck masses in adults often overlaps with the work-up of cancer of unknown primary site, we evaluated the utility of PET-CT scans to identify the presence of malignancy and the location of primary tumor.


METHODS
Single-institution retrospective case review series.


METHODS
We reviewed the PET-CT imaging of cystic neck masses occurring in five patients over 40 years of age with significant risk factors for SCCHN and correlated this information with histopathology.


RESULTS
In each patient in our series, the PET portion of a combined PET-CT was misleading, whereas the CT examination was more suggestive of the correct pathology. Ultimately, clinical judgment and endoscopic evaluation, guided by CT findings, were most valuable for distinguishing malignant versus benign processes and identifying the primary tumor sites.


CONCLUSIONS
PET-CT may not be a reliable modality for identifying malignancy in adults with suspicious cystic neck masses. A thorough clinical evaluation by an experienced head and neck surgeon, in conjunction with contrast-enhanced CT, may be sufficient to facilitate the optimal management of such patients.
Ferris
Robert L
RL
Department of Otolaryngology, University of Pittsburgh Cancer Institute, Hillman Cancer Center-Research Wing, Pittsburgh, Pennsylvania 15213, USA. ferrisrl@upmc.edu
Branstetter
Barton F
BF
Nayak
Jayakar V
JV
D000328:Adult; D044963:Biopsy, Fine-Needle; D003560:Cysts / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D015203:Reproducibility of Results