Interpreting PET Avid Contralateral Cervical Lymph Nodes in Oropharyngeal Carcinoma

Monday, October 2, 2023

8:54 AM - 9:00 AM East Coast USA Time

Location: 201AB

Presenting Author(s)

Aarti M. Agarwal, MD

Resident Physician
Thomas Jefferson University
Philadelphia, PA, United States

Co-Author(s)

Sruti Tekumalla, BA

Medical Student
Sidney Kimmel Medical College
Philadelphia, Pennsylvania, United States
Ramez Philips, MD

Medical Student
Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States
Arielle G. Thal, MD

Assistant Professor
Thomas Jefferson University
Philadelphia, PA, United States
David M. Cognetti, MD

Professor and Chair, Department of Otolaryngology
Thomas Jefferson University
Philadelphia, PA, United States
Adam J. Luginbuhl, MD

Professor
Department of Otolaryngology, Thomas Jefferson University
Philadelphia, PA, United States

Senior Author(s)

Joseph M. Curry, MD

Professor
Thomas Jefferson University Hospital
Wynnewood, PA, United States

Disclosure(s):

Sruti Tekumalla, BA: No relevant relationships to disclose.

Arielle G. Thal, MD: No relevant relationships to disclose.

Adam J. Luginbuhl, MD: No relevant relationships to disclose.

Introduction: PET avid contralateral nodes in patients with early-stage oropharyngeal squamous cell carcinoma (OPSCC) can be difficult to interpret clinically. We aim to evaluate the relationship between pathologically positive contralateral cervical nodes (pN+) and PET avidity in patients with OPSCC.

Methods: Retrospective cohort study. Patients with OPSCC who underwent preoperative PET scan followed by primary surgical resection and bilateral neck dissection from 2010-2021 were included. PET positivity was defined as SUV>1.5. Logistic regression analysis was performed to assess the characteristics of contralateral pN+ disease that correlated with PET positivity.

Results: 88 patients met inclusion criteria. 27 patients (30.7%) had PET avid nodes in the contralateral neck. Mean SUV of PET avid contralateral nodes ranged from 1.54 to 14.52. 6 patients (22%) had pathologically positive disease. Rates of contralateral pN+ disease were similar in patients with and without contralateral PET activity (27.3% vs 31.8%, p = 0.804). In patients with PET positive nodes, the mean SUV was 3.5 (1.6) vs 5.4 (4.7) in contralateral pN0 vs pN+ necks (p = 0.184). Increasing pathologic nodal size correlated with PET positivity (p < 0.001). Other nodal factors such as ENE, pN classification and primary tumor characteristics (primary site, p16+ status, pT classification, AJCC Stage, LVI, and PNI), did not correlate with PET avidity in patients with contralateral pN+.

Conclusions: Interpretation of SUV is unreliable in predicting pathologic contralateral nodal disease in patients with OPSCC. In patients with contralateral pN+, pathologic nodal size is the only predictor of PET positivity in our study.