Page 148 - New epidemiological and PSMA-expression based paradigms in salivary gland tumors

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Chapter 9
No convincing evidence for the presence of tubarial salivary glands
We thank Iwanaga et al. for their interpretation and comments regarding the presented evidence [12]. They state that the existence of the tubarial salivary glands is not proven for three reasons. First, PSMA PET/CT does not prove existence of a salivary gland. Second, histology does not prove existence of a salivary gland. Finally, it is anatomically incorrect to say this represents a newly discovered salivary gland.
This interpretation is not in agreement with statements in the original paper, as we show in the point-by-point response in the Supplementary material We thank Narayan et al. for forth bringing their interpretation of our paper [14]. Similar to the points mentioned earlier in this response to the letters, it interestingly shows that important nuances in the discussion section regarding interpretation of the findings by the original authors, seem not to have been noted by Narayan et al. Also, the radiotherapy term organ at risk (OAR) seems to have been incorrectly interpreted as the anatomical term ‘‘organ”. These misunderstandings might have resulted from the monodisciplinary anatomical background of the authors of the letter as in contrast to the multidisciplinary (7 specialty) team of authors of the original paper. The suggestions for further characterization are, however, thankfully taken. As is said in the title of our response, the original paper is a starting point.
The study design created considerable gender imbalance, with possible clinical consequences
We thank the authors Ellsworth et al. for their remarks on gender imbalance. We should have realized and mentioned these concerns in the limitations section [17] . To provide more insight in the female tubarial glands, we have now been able to examine six additional female patients that were scanned with PSMA PET/ CT for another study. We can report that all scanned women had the expected visual indications of tubarial glands, with a median cranio-caudal length of 3.3 cm (range 2.2–4.6 cm). This number is too low for an actual statistical comparison between the sexes, but it is comparable to the length of the gland in the 99 men in the paper: median 3.9 cm (range 1.0–5.7 cm).