18FDG Uptake in Sinonasal Inverted Papilloma Detected by Positron Emission Tomography/Computed Tomography

1. Introduction

Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumour that origins from the ectodermal epithelium of the nose and paranasal sinuses. Its endophytic growth results in erosion of surrounding stroma and bone. The inverted papilloma is a rare disease accounting from 0.5 to 4% of all nasal tumours [1], but its significance is related to the tendency to recur after removal. Recurrence of IP following surgery is correlated to several factors including tumor location, extent, and methods of removal, but the most important determinant of recurrence is the completeness of resection.

Aggressive surgical treatment has thus been traditionally recommended [2] because the risk of transformation in squamous carcinoma is estimated as 5–15% of cases [3].

These evidences support the use of diagnostic imaging, although the clinical evaluation is the main step in the evaluation of patients with IP. In particular CT and MRI are used to evaluate bone destruction and soft-tissue extension before surgery, but it may be ineffective to differentiate an inverted papilloma from squamous cell carcinoma [4, 5].

In recent years, F-18 Fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET) is widely used as diffuse imaging procedure for diagnosis and follow up of malignancy affecting the head and neck district [6].

In a previous study on patients with suspicious recurrence of IP we reported the ability of ¹⁸FDG-PET to detect the recurrence of IP in patients that presented a ¹⁸FDG-PET uptake in their lesion [7].

The purpose of this study was to evaluate the utility of ¹⁸FDG-PET/CT in the diagnosis of patients with suspicious lesions for IP.

2. Materials and Methods

2.1. Patients

The study has been carried out on 352 patients undergoing outpatient visit for sinonasal symptoms at the Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery at the University of Catanzaro, in the period between 2008 to 2010. All patients were submitted to a standard diagnostic workup composed of clinical examination and nasal endoscopy. A total of 12 patients were selected: 7 patients with suspected primary diagnosis of inverted papilloma, and 5 patients previously treated for IP with suspected recurrence of inverted papilloma. The selection criteria were: unilateral nasal obstruction, unilateral polypoid neoformation like, nasal discharge, and facial pain.

All patients included in...

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