Fig. 2

This patient presented with suspected metastatic nasopharyngeal cancer. Initial workup with endoscopic ultrasound and biopsy of the subcarinal node was non-diagnostic with necrotic tissue. FDG PET/CT demonstrates very intense uptake at all sites with lower uptake in the subcarinal node, only evident when widening the PET window. The findings suggest a different tumour biology at this site  with necrosis. When feasible, we recommend biopsy of the most FDG-avid lesion which likely represents the site of most aggressive disease and least likely to be non-diagnostic. In summary, the PET study windowed narrowly is primed for sensitivity whereas a wider window enables superior characterisation