In Response to Combination of panendoscopy and PET/CT increases detection of unknown primary head and neck carcinoma

The authors thank Dr. Sharma for his thoughtfulness and statistical recommendations. Dr. Sharma recommends the use of identification rate instead of sensitivity and specificity, as there is no gold-standard test for determining the unknown primary head and neck carcinoma. In this study, we tested the strength of positron emission tomography/computed tomography (PET/CT) in the detection of the unknown primary site against detection by endoscopy and biopsy.¹ According to Trevethan et al., the gold standard is the best single test or combination of tests currently in use as the preferred method of diagnosing a disease.² Although there is no defined gold standard of testing in unknown primary head and neck carcinoma, biopsy and pathologic diagnosis have long been accepted as methods of arriving at a true diagnosis.

The general crux of the article remains that PET/CT should not be used as the sole modality of diagnosis in unknown primary head and neck carcinoma. We appreciate Dr. Sharma’s thoughtfulness and additional consideration in the utility of identification rate in the diagnosis of unknown primary if a gold standard does not exist. These statistical considerations should be encouraged in otolaryngology literature authorship and readership.