Recurrent Nasopharyngeal Carcinoma Presenting as a Positron Emission Tomography False-negative Scan

Received 27 December 2008; received in revised form 7 January 2009; accepted 19 January 2009.

Abstract

Positron emission tomography (PET) is valuable for detecting locoregional recurrences of nasopharyngeal carcinoma (NPC) with a high sensitivity and fair specificity. A negative PET result is generally thought to confidently exclude the presence of a tumor. However, a false-negative PET scan is more dangerous than false-positive results because an undiscovered recurrent tumor may eventually lead to the patient's death without proper treatment. In this report, we describe a false-negative PET scan in a NPC patient with a recurrent tumor in the left cavernous sinus, presenting as a new onset of left 6th cranial nerve palsy 1 year after irradiation. The first magnetic resonance imaging (MRI) and PET scan failed to disclose any abnormalities. The second MRI performed 3 months after the first scans demonstrated a new abnormal lesion in the left cavernous sinus, which had resolved in the following MRI after re-irradiation. Therefore, clinical observation with suggestive symptoms is still important, even with negative imaging results. Close follow-up with a series of imaging studies must be performed when indicated.

Keywords: Cavernous sinus , Diplopia , Magnetic resonance imaging , Nasopharyngeal carcinoma , Positron emission tomography

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References

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a Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

b Department of Otolaryngology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan

c Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

d Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Corresponding author. Department of Otolaryngology, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, Taiwan

PII: S1016-3190(09)60064-1

doi:10.1016/S1016-3190(09)60064-1

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