Abstract
Objective
PET/CT in sinonasal malignancies is largely undefined. The objective of this study was to evaluate PET/CT in the initial staging and oncologic surveillance of paranasal sinus carcinomas.
Methods
Retrospective review was performed of patients undergoing PET/CT for sinonasal neoplasms from 2001–2006 at tertiary care referral center. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of PET/CT were calculated. The gold standard was histology and clinical course when histology was not available. Any uptake in PET was considered a positive study.
Results
78 PET/CT scans were reviewed from 32 patients. Most common histopathologies included esthesioneuroblastoma (28.1%), sinonasal undifferentiated carcinoma (18.8%), sinonasal melanoma (18.8%), squamous cell carcinoma (18.8%), and adenosquamous carcinoma (9%). Overall sensitivity and specificity of PET/CT was 89% and 90% with PPV of 67% and NPV of 98%. PPV at the primary site, neck, and distant sites was 81%, 47% and 69%; NPV was 94%, 100%, and 98% respectively. For initial staging, 9.5% of patients were accurately upstaged at the neck or distant sites. During restaging, 29.6% of patients were accurately upstaged at the neck or distant sites.
Conclusions
PET/CT serves as a useful adjunct to conventional imaging in initial staging and restaging of sinonasal malignancies. Negative studies are effective in predicting the absence of disease as seen in the consistently higher NPV. Positive studies need to be examined with caution, given the high rate of false positive studies. When viewed along with clinical exam and focused biopsies, they may effectively result in upstaging patients as noted in our series.
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