Incidental FDG‐Avid Focuses in Palatine Tonsils on PET/CT

OBJECTIVES: The management of incidental findings of FDG‐avid tonsils on PET/CT (IFT) is unclear. We aimed to explore the prevalence of malignancy in IFT, identify risk factors for malignancy, and calculate optimal cutoffs of maximum standardized uptake values (SUV(max)) to discriminate between benign and malignant lesions. METHODS: All patients who were tonsillectomized at our institution because of IFT from October 2011 to December 2020 were included. Patients undergoing PET/CT due to suspected tonsillar disease or cancer of unknown primary were excluded. RESULTS: In total, 77 patients were included, of which 11 (14%) of them had IFT malignancy. Dysphagia (p = 0.019) and alcohol abuse (p = 0.035) were associated with malignancy. Absolute SUV(max) cutoff (≥9: sensitivity 100%; specificity 53%) was superior to SUV(max) side‐to‐side ratio (≥1.5: sensitivity 64%; specificity 70%) to discriminate between benign and malignant lesions. CONCLUSION: We recommend tonsillectomy for patients with IFT displaying SUV(max) ≥ 9.0, ratio ≥ 1.5, or symptoms or findings suggesting malignancy. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2370–2378, 2022