Is There a Role for PET/CT Parameters to Characterize Benign, Malignant, and Metastatic Parotid Tumors?
OBJECTIVE
Assessment of benign and malignant lesions of the parotid gland, including metastatic lesions, is challenging with current imaging methods. Fluorine-18 FDG PET/CT is a noninvasive imaging modality that provides both anatomic and metabolic information. Semiquantitative data obtained from PET/CT, also known as PET/CT parameters, are maximum, mean, or peak standardized uptake values (SUVs); metabolic tumor volume; total lesion glycolysis; standardized added metabolic activity; and normalized standardized added metabolic activity. Our aim was to determine whether FDG PET/CT parameters can differentiate benign, malignant, and metastatic parotid tumors.


METHODS
Thirty-four patients with parotid neoplasms underwent PET/CT before parotidectomy; maximum SUV, mean SUV, peak SUV, total lesion glycolysis, metabolic tumor volume, standardized added metabolic activity, and normalized standardized added metabolic activity were calculated on a dedicated workstation. Univariate analyses were performed. A ROC analysis was used to determine the ability of PET/CT parameters to predict pathologically proven benign, malignant, and metastatic parotid gland neoplasms.


RESULTS
Fourteen patients had a benign or malignant primary parotid tumor. Twenty had metastases to the parotid gland. When the specificity was set to at least 85% for each parameter to identify cut points, the corresponding sensitivities ranged from 15% to 40%. Assessment of benign versus malignant lesions of parotid tumors, as well as metastasis from squamous cell carcinoma versus other metastatic causes, revealed that none of the PET/CT parameters has enough power to differentiate among these groups.


CONCLUSIONS
PET/CT parameters, including total lesion glycolysis, metabolic tumor volume, standardized added metabolic activity, and normalized standardized added metabolic activity, are not able to differentiate benign from malignant parotid tumors, primary parotid tumors from metastasis, or metastasis from squamous cell carcinoma and nonsquamous cell carcinoma metastasis.
1 Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322.
Ayse Tuba Karagulle
AT
Kendi
2 Department of Pathology, Emory University, Atlanta, GA.
Kelly R
KR
Magliocca
1 Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322.
Amanda
A
Corey
1 Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322.
James R
JR
Galt
3 Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA.
Jeffrey
J
Switchenko
4 Department of Otolaryngology, Head and Neck Surgery, Emory University, Atlanta, GA.
J Trad
JT
Wadsworth
4 Department of Otolaryngology, Head and Neck Surgery, Emory University, Atlanta, GA.
Mark W
MW
El-Deiry
1 Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322.
David M
DM
Schuster
5 Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA.
Nabil F
NF
Saba
1 Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322.
Patricia A
PA
Hudgins
D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010307:Parotid Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden
D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
FDG; PET/CT; benign; malignant; parameter; parotid; tumor