The hypermetabolic activity for BOT, midline, is uncertain, according to the PET, so only a biopsy can tell if it is cancer, high SUV is a strong indicator too. If there were two or more lymph nodes involved they would do chemo, and also depends on the thickness of the tumor, grade. BOT involvement can go to bilateral sides, and anything midline on the tongue also. Lymph nodes for orophargeal..BOT usually go to level II first, and oral..tongue cancer in level I, but there can be skip Metasteses.

I forgot you had root canal the same week as the PET, which can show hyperactivity in the mouth. Anyway, you are in good hands with Dr, Shah, and read of him, his work, the last few years. Good luck!