In Reply We thank Stokes et al for their interest in our article regarding contralateral nodal metastases in patients with human papillomavirus–related base of tongue carcinoma. Their first question relates to how we can clinically identify patients with nodal metastases using positron emission tomographic (PET) imaging. In our study, 53 of the 70 patients (76%) with no clinically evident contralateral nodal disease had PET or PET/computed tomographic (CT) images available for review. Of the 15 patients with occult contralateral pathologic nodal disease, 11 (73%) had PET or PET/CT imaging. The remainder of the patients had CT neck and chest imaging. Data were collected from 2002 until 2018, and most patients without PET data were early in the series. Images were interpreted visually, without considering standardized uptake values. Also of note is that combined PET/CT machines were not routinely available at our institution before 2005. It is possible that PET/CT could have helped identify occult contralateral nodal disease in the 4 patients who lacked PET/CT imaging but had occult contralateral nodal disease. Because PET/CT imaging was used in most of these patients, this likely would not change our overall outcomes and recommendation that the contralateral clinically negative nodal basin should receive elective treatment, especially if the tumor crosses midline.
Πέμπτη 2 Απριλίου 2020
Detection and Implications of Occult Contralateral Nodal Spread in Human Papillomavirus–Associated Base of Tongue Cancer—Reply
Detection and Implications of Occult Contralateral Nodal Spread in Human Papillomavirus–Associated Base of Tongue Cancer—Reply:
In Reply We thank Stokes et al for their interest in our article regarding contralateral nodal metastases in patients with human papillomavirus–related base of tongue carcinoma. Their first question relates to how we can clinically identify patients with nodal metastases using positron emission tomographic (PET) imaging. In our study, 53 of the 70 patients (76%) with no clinically evident contralateral nodal disease had PET or PET/computed tomographic (CT) images available for review. Of the 15 patients with occult contralateral pathologic nodal disease, 11 (73%) had PET or PET/CT imaging. The remainder of the patients had CT neck and chest imaging. Data were collected from 2002 until 2018, and most patients without PET data were early in the series. Images were interpreted visually, without considering standardized uptake values. Also of note is that combined PET/CT machines were not routinely available at our institution before 2005. It is possible that PET/CT could have helped identify occult contralateral nodal disease in the 4 patients who lacked PET/CT imaging but had occult contralateral nodal disease. Because PET/CT imaging was used in most of these patients, this likely would not change our overall outcomes and recommendation that the contralateral clinically negative nodal basin should receive elective treatment, especially if the tumor crosses midline.
In Reply We thank Stokes et al for their interest in our article regarding contralateral nodal metastases in patients with human papillomavirus–related base of tongue carcinoma. Their first question relates to how we can clinically identify patients with nodal metastases using positron emission tomographic (PET) imaging. In our study, 53 of the 70 patients (76%) with no clinically evident contralateral nodal disease had PET or PET/computed tomographic (CT) images available for review. Of the 15 patients with occult contralateral pathologic nodal disease, 11 (73%) had PET or PET/CT imaging. The remainder of the patients had CT neck and chest imaging. Data were collected from 2002 until 2018, and most patients without PET data were early in the series. Images were interpreted visually, without considering standardized uptake values. Also of note is that combined PET/CT machines were not routinely available at our institution before 2005. It is possible that PET/CT could have helped identify occult contralateral nodal disease in the 4 patients who lacked PET/CT imaging but had occult contralateral nodal disease. Because PET/CT imaging was used in most of these patients, this likely would not change our overall outcomes and recommendation that the contralateral clinically negative nodal basin should receive elective treatment, especially if the tumor crosses midline.
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