title: FDG-PET/CT can rule out malignancy in patients with vocal cord palsy.
abstract: The aim was to investigate the performance of (18)F-fluorodeoxyglucose PET/CT to rule out malignancy in patients with confirmed vocal cord palsy (VCP). Between January 2011 and June 2013, we retrospectively included consecutive patients referred to PET/CT with paresis or paralysis of one or both vocal cords. PET/CT results were compared to clinical workup and histopathology. The study comprised 65 patients (32 females) with a mean age of 66±12 years (range 37-89). Eleven patients (17%) had antecedent cancer. Twenty-seven (42%) were diagnosed with cancer during follow-up. The palsy was right-sided in 24 patients, left-sided in 37, and bilateral in 4. Median follow-up was 7 months (interquartile range 4-11 months). Patients without cancer were followed for at least three months. PET/CT suggested a malignancy in 35 patients (27 true positives, 8 false positives) and showed none in 30 (30 true negatives, 0 false negatives). Thus, the sensitivity, specificity, positive and negative predictive values, and accuracy were (95% confidence intervals in parenthesis): 100% (88%-100%), 79% (64%-89%), 77% (61%-88%), 100% (89%-100%), and 88% (78%-94%), respectively. Sixteen patients had palliative treatment, while 11 were treated with curative intent, emphasising the severity of VCP and the need for a rapid and accurate diagnostic work-up. In this retrospective survey, biopsy proven malignancy (whether newly diagnosed or relapsed) was the cause of VCP in almost half of patients (42%). PET/CT had a high sensitivity (100%) with a relatively high false positive rate, but was excellent in ruling out malignancy (negative predictive value 100%).
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Thomassen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Anne Lerberg
authors.initials: AL
authors.lastname: Nielsen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Jeppe Kiilerich
authors.initials: JK
authors.lastname: Lauridsen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Björn Alexander
authors.initials: BA
authors.lastname: Blomberg
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Hess
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Petersen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Allan
authors.initials: A
authors.lastname: Johansen
authors.affiliation: Department of Radiology, Odense University Hospital Denmark.
authors.forename: Jon Thor
authors.initials: JT
authors.lastname: Asmussen
authors.affiliation: Department of ENT Head and Neck Surgery, Odense University Hospital Denmark.
authors.forename: Jesper Roed
authors.initials: JR
authors.lastname: Sørensen
authors.affiliation: Department of Oncology, Odense University Hospital Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Johansen
authors.affiliation: Department of ENT Head and Neck Surgery, Odense University Hospital Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Godballe
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital Denmark.
authors.forename: Poul Flemming
authors.initials: PF
authors.lastname: Høilund-Carlsen
keywords: FDG-PET/CT; laryngeal nerve; palsy; paralysis; paresis; vocal cord
references.citation: Otolaryngol Head Neck Surg. 2004 Jun;130(6):788-90
references.pmid: 15195068
references.citation: Ann Otol Rhinol Laryngol. 2005 Mar;114(3):202-6
references.pmid: 15825569
references.citation: AJR Am J Roentgenol. 2009 Jan;192(1):288-94
references.pmid: 19098212
references.citation: Rev Esp Med Nucl Imagen Mol. 2012 Nov-Dec;31(6):362-3
references.pmid: 23084020
references.citation: Auris Nasus Larynx. 2002 Jan;29(1):41-5
references.pmid: 11772489
references.citation: Eur J Nucl Med Mol Imaging. 2011 May;38(5):894-8
references.pmid: 21340453
references.citation: Laryngoscope. 2011 Feb;121(2):335-8
references.pmid: 21271584
references.citation: J Thorac Oncol. 2008 Oct;3(10):1172
references.pmid: 18827615
references.citation: ORL J Otorhinolaryngol Relat Spec. 2007;69(3):167-71
references.pmid: 17264533
references.citation: Semin Nucl Med. 2012 Jul;42(4):267-80
references.pmid: 22681676
references.citation: Ugeskr Laeger. 2009 Jan 12;171(3):109-12
references.pmid: 19174016
references.citation: Q J Nucl Med Mol Imaging. 2009 Feb;53(1):9-19
references.pmid: 18337683
references.citation: Ann Nucl Med. 2012 Jun;26(5):405-11
references.pmid: 22427268
references.citation: J Nucl Med. 1996 Nov;37(11):1771-3
references.pmid: 8917172
references.citation: Int J Mol Imaging. 2012;2012:165080
references.pmid: 23316356
references.citation: Radiology. 2002 Jul;224(1):153-6
references.pmid: 12091675
references.citation: Eur Arch Otorhinolaryngol. 2014 May;271(5):1163-70
references.pmid: 23775302