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Willemse JRJ, Lambregts DMJ, Balduzzi S, Schats W, Snaebjornsson P, Marchetti S, Vollebergh MA, van Golen LW, Cheung Z, Vogel WV, Bodalal Z, Rostami S, Gerke O, Sivakumaran T, Beets-Tan RGH, Lahaye MJ. Identifying the primary tumour in patients with cancer of unknown primary (CUP) using [ 18F]FDG PET/CT: a systematic review and individual patient data meta-analysis. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06860-1. [PMID: 39141069 DOI: 10.1007/s00259-024-06860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE In this systematic review and individual patient data (IPD) meta-analysis, we analysed the diagnostic performance of [18F]FDG PET/CT in detecting primary tumours in patients with CUP and evaluated whether the location of the predominant metastatic site influences the diagnostic performance. METHODS A systematic literature search from January 2005 to February 2024 was performed to identify articles describing the diagnostic performance of [18F]FDG PET/CT for primary tumour detection in CUP. Individual patient data retrieved from original articles or obtained from corresponding authors were grouped by the predominant metastatic site. The diagnostic performance of [18F]FDG PET/CT in detecting the underlying primary tumour was compared between predominant metastatic sites. RESULTS A total of 1865 patients from 32 studies were included. The largest subgroup included patients with predominant bone metastases (n = 622), followed by liver (n = 369), lymph node (n = 358), brain (n = 316), peritoneal (n = 70), lung (n = 67), and soft tissue (n = 23) metastases, leaving a small group of other/undefined metastases (n = 40). [18F]FDG PET/CT resulted in pooled detection rates to identify the primary tumour of 0.74 (for patients with predominant brain metastases), 0.54 (liver-predominant), 0.49 (bone-predominant), 0.46 (lung-predominant), 0.38 (peritoneal-predominant), 0.37 (lymph node-predominant), and 0.35 (soft-tissue-predominant). CONCLUSION This individual patient data meta-analysis suggests that the ability of [18F]FDG PET/CT to identify the primary tumour in CUP depends on the distribution of metastatic sites. This finding emphasises the need for more tailored diagnostic approaches in different patient populations. In addition, alternative diagnostic tools, such as new PET tracers or whole-body (PET/)MRI, should be investigated.
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Affiliation(s)
- Jeroen R J Willemse
- Department of Radiology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
- GROW Research Institute for Oncology and Reproduction - Maastricht University, Maastricht, Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
- GROW Research Institute for Oncology and Reproduction - Maastricht University, Maastricht, Netherlands
| | - Sara Balduzzi
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Winnie Schats
- Department of Scientific Information Service, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Serena Marchetti
- Department of Medical Oncology and Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Marieke A Vollebergh
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Larissa W van Golen
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Zing Cheung
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Zuhir Bodalal
- Department of Radiology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
- GROW Research Institute for Oncology and Reproduction - Maastricht University, Maastricht, Netherlands
| | - Sajjad Rostami
- Department of Radiology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
- GROW Research Institute for Oncology and Reproduction - Maastricht University, Maastricht, Netherlands
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Tharani Sivakumaran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne VIC, Melbourne, VIC, Australia
| | - Regina G H Beets-Tan
- Department of Radiology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
- GROW Research Institute for Oncology and Reproduction - Maastricht University, Maastricht, Netherlands
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Max J Lahaye
- Department of Radiology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands.
- GROW Research Institute for Oncology and Reproduction - Maastricht University, Maastricht, Netherlands.
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Ekmen MÖ, Aksoy EK. Evaluation of patients via colonoscopy who underwent positron emission tomography/computerized tomography due to colon involvement. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230409. [PMID: 37792869 PMCID: PMC10547485 DOI: 10.1590/1806-9282.20230409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Fluorodeoxyglucose is not a tumor-specific agent and it can also be involved in benign conditions, which may cause diagnostic confusion. This research aims to elucidate the colonoscopic findings of patients who underwent colonoscopy due to colon involvement in positron emission tomography/computerized tomography. METHODS A total of 71 patients who underwent colonoscopy due to colonic involvement in positron emission tomography/computerized tomography at SBU Keçiören Training and Research Hospital Gastroenterology Clinic Endoscopy Unit have been analyzed retrospectively. Demographic characteristics of the patients, areas of involvement in positron emission tomography/computerized tomography, and severity have been obtained from the hospital database. RESULTS The gastrointestinal involvement area of 22.5% (n=16) of the patients was ascending colon, 15.5% (n=11) was sigmoid, 15.5% (n=11) was rectum, 12.7% (n=9) was stomach, 11.3% (n=8) was transverse colon, 8.5% (n=6) was anal canal, 5.6% (n=4) was esophagus, and 5.6% (n=4) was descending colon. The endoscopic findings of 19.7% (n=14) patients were normal, whereas 29.6% (n=21) had polyps, 9.9% (n=7) had cancer, 2.8% (n=2) had an ulcer, 15.5% (n=11) had gastritis, 14.1% (n=10) had hemorrhoids, and 7% (n=5) had colitis. CONCLUSION Fluorodeoxyglucose-positron emission tomography can detect unexpected distant metastases with high sensitivity because it allows whole-body imaging. Curative resection significantly contributes to the choice of treatment modality in the pre-operative period of colorectal cancer patients with planned surgery.
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Affiliation(s)
- Mehmet Önder Ekmen
- Ankara SBU Keçiören Training and Research Hospital Gastroenterology Clinic – Ankara, Turkey
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Soni N, Ora M, Aher PY, Mishra P, Maheshwarappa RP, Priya S, Graham MM. Role of FDG PET/CT for detection of primary tumor in patients with extracervical metastases from carcinoma of unknown primary. Clin Imaging 2021; 78:262-270. [PMID: 34174653 DOI: 10.1016/j.clinimag.2021.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) to detect the primary tumor site in patients with extracervical metastases from carcinoma of unknown primary (CUP). We evaluated patient outcomes as overall survival (OS). MATERIALS AND METHODS In a single-center, retrospective study (2005-2019), patients with extracervical metastases from CUP underwent FDG PET/CT to detect primary tumor sites. The final diagnosis was based on histopathology/or clinical follow-up of at least 12 months. RESULTS A total of 83 patients [Male 41 (49%), mean age 59 ± 14 years, range: 32-83 years] fulfilled the inclusion/exclusion criteria and were enrolled for analysis. The primary tumor was detected in 36 out of 83 (43%) patients based on histopathology/or clinical follow-up. PET/CT suggested the primary tumor site in 39 (47%) patients with diagnostic accuracy of 87%, sensitivity 89%, specificity 85%, PPV 82%, NPV 91% and detection rate 39%. Patients with oligometastases (<3) (2.16 years, 1.04-2.54) and primary unidentified (1 year, 0.34-2.14) had longer median survival time compared to the patients with multiple metastases (0.67 years, 0.17-1.58, p = 0.009) and primary identified (0.67 years,0.16-1.33, p = 0.002). The SUVmax of the primary or metastatic lesions with maximum uptake was not significantly related to survival. CONCLUSIONS PET/CT could reveal the primary tumor site in 39% of the patients. It demonstrated the metastatic disease burden and distribution in patients with 'primary obscured', which directs management. Patients with multiple metastases and primary identified had a poorer prognosis. In patients with primary unidentified after PET/CT, a further search was futile.
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Affiliation(s)
- Neetu Soni
- Nuclear Medicine Resident at University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52246, USA.
| | - Manish Ora
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Pritish Y Aher
- Fellow Chest Imaging, Radiology Department, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52246, USA
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Sarv Priya
- Resident Radiology Department, UIHC, Iowa city 52246, IA, USA.
| | - Michael M Graham
- Radiology - Division of Nuclear Medicine, Radiation Oncology, 3863 JPP, Iowa City, IA 52242, USA.
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Zytoon AA, Elsayed EE, Nassar AI, Murakami K. Pivotal role of PET/CT in characterization of occult metastasis with undetermined origin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this multicenter diagnostic accuracy test study was conducted to assess the role of positron emission tomography/computed tomography in the detection of primary tumor in cases of metastasis of undetermined primary site, to estimate its capability in detecting additional lesions as well as evaluating disease burden and staging. This multicentric diagnostic accuracy test study included 175 patients with pathologically proven, radiologically, and/or clinically suspected metastatic lesions of undetermined primary site. Clinical, surgical, and histopathologic findings and correlative imaging modalities were used to assess the results of PET/CT; the accuracy of PET/CT was expressed in terms of sensitivity and specificity, positive and negative predictive values.
Results
The study included 175 patients; PET-CT-positive lesions suggestive of primary malignant tumors were detected in 105 out of 175 patients. These lesions were pathologically proven to be malignant (true positive) in 100/175 patients (57.1%). Five out of 175 patients (2.9%) proved to be falsely positive after pathologic assessment; 70 out of 175 patients (40%) were negative for detection of primary malignancy all over the body by PET/CT (true negative) with no false negative results. PET/CT achieved a sensitivity of 100%, and specificity of 93.3% in detection of unknown primary tumor location.
Conclusion
PET/CT is an effective modality for early detection of the primary tumor site in patients with cancer of undetermined primary (CUP) which facilitates early selection of appropriate treatment protocols that will improve patients’ prognosis.
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Liu X, Li L, Peng L, Wang B, Lang J, Lu Q, Zhang X, Sun Y, Tian G, Zhang H, Zhou L. Predicting Cancer Tissue-of-Origin by a Machine Learning Method Using DNA Somatic Mutation Data. Front Genet 2020; 11:674. [PMID: 32760423 PMCID: PMC7372518 DOI: 10.3389/fgene.2020.00674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
Patients with carcinoma of unknown primary (CUP) account for 3-5% of all cancer cases. A large number of metastatic cancers require further diagnosis to determine their tissue of origin. However, diagnosis of CUP and identification of its primary site are challenging. Previous studies have suggested that molecular profiling of tissue-specific genes could be useful in inferring the primary tissue of a tumor. The purpose of this study was to evaluate the performance somatic mutations detected in a tumor to identify the cancer tissue of origin. We downloaded the somatic mutation datasets from the International Cancer Genome Consortium project. The random forest algorithm was used to extract features, and a classifier was established based on the logistic regression. Specifically, the somatic mutations of 300 genes were extracted, which are significantly enriched in functions, such as cell-to-cell adhesion. In addition, the prediction accuracy on tissue-of-origin inference for 3,374 cancer samples across 13 cancer types reached 81% in a 10-fold cross-validation. Our method could be useful in the identification of cancer tissue of origin, as well as the diagnosis and treatment of cancers.
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Affiliation(s)
- Xiaojun Liu
- School of Computer Science, Hunan University of Technology, Zhuzhou, China
| | | | - Lihong Peng
- School of Computer Science, Hunan University of Technology, Zhuzhou, China
| | - Bo Wang
- Genesis Beijing Co., Ltd., Beijing, China
| | | | | | | | - Yi Sun
- Chifeng Municipal Hospital, Chifeng, China
| | - Geng Tian
- Genesis Beijing Co., Ltd., Beijing, China
| | - Huajun Zhang
- College of Mathematics and Computer Science, Zhejiang Normal University, Jinhua, China
| | - Liqian Zhou
- School of Computer Science, Hunan University of Technology, Zhuzhou, China
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He B, Lang J, Wang B, Liu X, Lu Q, He J, Gao W, Bing P, Tian G, Yang J. TOOme: A Novel Computational Framework to Infer Cancer Tissue-of-Origin by Integrating Both Gene Mutation and Expression. Front Bioeng Biotechnol 2020; 8:394. [PMID: 32509741 PMCID: PMC7248358 DOI: 10.3389/fbioe.2020.00394] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023] Open
Abstract
Metastatic cancers require further diagnosis to determine their primary tumor sites. However, the tissue-of-origin for around 5% tumors could not be identified by routine medical diagnosis according to a statistics in the United States. With the development of machine learning techniques and the accumulation of big cancer data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), it is now feasible to predict cancer tissue-of-origin by computational tools. Metastatic tumor inherits characteristics from its tissue-of-origin, and both gene expression profile and somatic mutation have tissue specificity. Thus, we developed a computational framework to infer tumor tissue-of-origin by integrating both gene mutation and expression (TOOme). Specifically, we first perform feature selection on both gene expressions and mutations by a random forest method. The selected features are then used to build up a multi-label classification model to infer cancer tissue-of-origin. We adopt a few popular multiple-label classification methods, which are compared by the 10-fold cross validation process. We applied TOOme to the TCGA data containing 7,008 non-metastatic samples across 20 solid tumors. Seventy four genes by gene expression profile and six genes by gene mutation are selected by the random forest process, which can be divided into two categories: (1) cancer type specific genes and (2) those expressed or mutated in several cancers with different levels of expression or mutation rates. Function analysis indicates that the selected genes are significantly enriched in gland development, urogenital system development, hormone metabolic process, thyroid hormone generation prostate hormone generation and so on. According to the multiple-label classification method, random forest performs the best with a 10-fold cross-validation prediction accuracy of 96%. We also use the 19 metastatic samples from TCGA and 256 cancer samples downloaded from GEO as independent testing data, for which TOOme achieves a prediction accuracy of 89%. The cross-validation validation accuracy is better than those using gene expression (i.e., 95%) and gene mutation (53%) alone. In conclusion, TOOme provides a quick yet accurate alternative to traditional medical methods in inferring cancer tissue-of-origin. In addition, the methods combining somatic mutation and gene expressions outperform those using gene expression or mutation alone.
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Affiliation(s)
- Binsheng He
- Academician Workstation, Changsha Medical University, Changsha, China
| | | | - Bo Wang
- Geneis Beijing Co., Ltd., Beijing, China
| | | | | | - Jianjun He
- Academician Workstation, Changsha Medical University, Changsha, China
| | - Wei Gao
- Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Pingping Bing
- Academician Workstation, Changsha Medical University, Changsha, China
| | - Geng Tian
- Geneis Beijing Co., Ltd., Beijing, China
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Herruer JM, Taylor SM, MacKay CA, Ubayasiri KM, Lammers D, Kuta V, Bullock MJ, Corsten MJ, Trites JRB, Rigby MH. Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors. Otolaryngol Head Neck Surg 2020; 162:313-318. [PMID: 31987002 DOI: 10.1177/0194599819900794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Surgical management of the unknown primary head and neck squamous cell carcinoma (UP HNSCC) remains controversial due to challenging clinical diagnosis. This study compares positron emission tomography-computed tomography (PET-CT) findings with intraoperative identification of primary tumors and compares intraoperative frozen-section margins to final histopathology. In addition, adjuvant therapy indications are provided. STUDY DESIGN Prospective cohort study. SETTING Academic university hospital. SUBJECTS AND METHODS Sixty-one patients with UP HNSCC were included. Patients received PET-CT, followed by oropharyngeal transoral laser microsurgery (TLM). Margins were assessed intraoperatively using frozen sections and afterward by final histopathology. Adjuvant treatment was based on final histopathology. RESULTS The sensitivity of localizing the primary tumor with PET-CT was 50.9% with a specificity of 82.5%. The primary tumor was found intraoperatively on frozen sections in 82% (n = 50) of patients. Five more tumors were identified on final histopathology, leading to a total of 90% (n = 55). Of the 50 intraoperatively found tumors, 98% (n = 49) had negative margins on frozen sections, and 90% (n = 45) were truly negative on final histopathology. Eighteen patients (29.5%) avoided adjuvant treatment. CONCLUSION PET-CT localized the primary tumor in fewer than half the cases. This protocol identified 90% of primary tumors. Intraoperative frozen-section margin assessment has shown potential with a specificity of 92% compared to final histopathology. As a result, adjuvant therapy was avoided in almost one-third of our patients.
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Affiliation(s)
- Jasmijn M Herruer
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colin A MacKay
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kishan M Ubayasiri
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Deanna Lammers
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Victoria Kuta
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin J Bullock
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin J Corsten
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Nagano N, Suzuki M, Tamura K, Kobayashi S, Kojima Y, Naka G, Iikura M, Izumi S, Takeda Y, Sugiyama H. Refractory Chylothorax and Lymphedema Caused by Advanced Gastric Cancer. Intern Med 2019; 58:3143-3148. [PMID: 31292374 PMCID: PMC6875443 DOI: 10.2169/internalmedicine.2351-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Chylothorax is the accumulation of lipid pleural effusion. Few reports have described chylothorax caused by gastric cancer. A 45-year-old woman presented with progressive lymphedema and bilateral chylothorax. Although repetitive thoracentesis was performed to relieve her dyspnea, swelling of her axillary lymph nodes became significant. Positron emission tomography/computed tomography demonstrated the accumulation of 18F-fluorodeoxyglucose in these nodes, and a lymph node biopsy showed signet ring cell carcinoma. The primary site was a 0-IIc type lesion in the gastric body that was only detected by upper gastrointestinal endoscopy. The patient was diagnosed with advanced gastric cancer 3.5 months after presentation for chylothorax.
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Affiliation(s)
- Naoko Nagano
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Kentaro Tamura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Sakurako Kobayashi
- Department of Gastroenterology, National Center for Global Health and Medicine, Japan
| | - Yasushi Kojima
- Department of Gastroenterology, National Center for Global Health and Medicine, Japan
| | - Go Naka
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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Cetin Avci N, Hatipoglu F, Alacacıoglu A, Bayar EE, Bural GG. FDG PET/CT and Conventional Imaging Methods in Cancer of Unknown Primary: an Approach to Overscanning. Nucl Med Mol Imaging 2018; 52:438-444. [PMID: 30538775 DOI: 10.1007/s13139-018-0544-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the performance of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) with conventional imaging methods (CIM), including computed tomography (CT), magnetic resonance imaging (MRI), and mammography (MMG) in cancer of unknown primary (CUP). Methods A total of 36 patients with CUP, who referred to our clinic for a FDG PET/CT scan, were enrolled in this study. Thirty of the patients were also examined through either diagnostic CT/MRI and/or MMG. The diagnostic performance of both methods for the primary cancer location was analyzed. The results of FDG PET/CT and CIM were compared based on the standard reference of the histopathology and/or clinical and laboratory follow-up. Results The primary cancer locations were detected in 24 patients (66.6%, 24/36) by FDG PET/CT, whereas CIM identified the locations in 16 patients (53.3%, 16/30). Sensitivity, specificity, PPV, NPV, and accuracy rates of the detection of the primary tumor localizations were as follows: 83, 70, 89, 58, and 79% for FDG PET/CT; 70, 62, 84, 42, and 68% for CIM, respectively. There was no statistical significance between modalities regarding any of the categories in 30 patients. Conclusion FDG PET/CT detected the primary tumors of the patients with CUP more than CIM did. However, the difference between them was not found to be statistically significant. It may be considered that FDG PET/CT scan can be performed as a first-line tool in the initial diagnosis of the patients with CUP and to add radiodiagnostic imaging in selective cases. We conclude that if the first-line examination of a CUP patient has been already performed by a CIM and the result was negative or inconclusive, FDG PET/CT can be considered to avoid unnecessary imaging procedures.
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Affiliation(s)
- Neslihan Cetin Avci
- 1Department of Nuclear Medicine, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey
| | - Filiz Hatipoglu
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Ahmet Alacacıoglu
- 3Department of Internal Medicine and Oncology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Emine Ebru Bayar
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Gonca Gul Bural
- 4Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Cancer of unknown primary origin: Can FDG PET/CT have a role in detecting the site of primary? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Karapetis CS, Guccione L, Tattersall MHN, Gooden H, Vajdic CM, Lambert S, Robotin M, Mileshkin L, Schofield P. Perceptions of cancer of unknown primary site: a national survey of Australian medical oncologists. Intern Med J 2017; 47:408-414. [PMID: 28101916 DOI: 10.1111/imj.13373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite being the sixth most common cause of cancer death in Australia, cancer of unknown primary (CUP) site remains poorly understood. AIMS To describe practices relating to the diagnosis, investigation, classification, communication and management of CUP among medical oncologists. METHODS We invited all members of the Medical Oncology Group of Australia to participate in a national, anonymous online survey about CUP. The survey collected data regarding diagnosis acceptance, diagnostic tests, treatment protocols and communication practices around the diagnosis of CUP. RESULTS Three hundred and two oncologists were invited and 86 (28%) completed the survey. Eighty (93%) respondents were directly involved in the assessment of patients with CUP. Eighty-five (99%) respondents were prepared to make a diagnosis of CUP if, after appropriate diagnostic tests, the primary location could not be ascertained. Eighty-three percent would assign a primary site to obtain Pharmaceutical Benefits Schedule funding of medical therapy. Sixty-two percent did not have a specific treatment protocol designed for CUP. The majority of oncologists used serum tumour markers and computed tomography scans in the initial work-up, while 43% indicated they would use a positron emission tomography scan in the majority of cases. The majority would arrange mammography in female patients. Thematic analysis of responses to open-ended questions about how CUP is described identified little consistency in the language being used. CONCLUSION The approach to diagnosis, investigation and management of CUP by medical oncologists in Australia is variable. Many preferred to estimate the primary site and treat accordingly. Pharmaceutical Benefits Schedule restrictions may encourage the practice of 'best guessing'.
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Affiliation(s)
- Christos S Karapetis
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lisa Guccione
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Martin H N Tattersall
- Sydney Medical School and Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Helen Gooden
- Cancer Australia, Sydney, New South Wales, Australia
| | - Claire M Vajdic
- Cancer Epidemiology Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sylvie Lambert
- Ingram School of Nursing, St Mary's Research Centre, McGill University, Montreal, Quebec, Canada
| | - Monica Robotin
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.,Faculty of Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Linda Mileshkin
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
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Kuta V, Williams B, Rigby M, Hart R, Trites J, MacKay C, Taylor SM. Management of head and neck primary unknown squamous cell carcinoma using combined positron emission tomography-computed tomography and transoral laser microsurgery. Laryngoscope 2017; 128:2307-2311. [PMID: 29214640 DOI: 10.1002/lary.27034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/29/2017] [Accepted: 11/06/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS The unknown primary of the neck is commonly encountered by the head and neck surgeon. Despite the exhaustive diagnostic tools employed in traditional detection protocols, many unknown primaries are not found, and the patient is subjected to wide-field radiation and chemotherapy during treatment. Localizing the primary tumor has demonstrated therapeutic benefits, improved quality of life, and overall survival. The authors' objective was to determine the efficacy of a new management protocol for unknown primaries of the head and neck. STUDY DESIGN Prospective cohort study. METHODS Our technique involved a preoperative positron emission tomography-computed tomography (PET-CT) followed by a planned transoral laser microsurgery (TLM) approach. Efficacy was assessed based on survival statistics, disease control, detection rates, the proportion of patients not receiving adjuvant therapy, and the proportion of PET-CT scans helpful for detection of the primary cancer. RESULTS The occult primary was located in 25 of the 27 patients (93%), with the majority found in the palatine tonsil (52%). Both overall survival and disease-specific survival was 80% at 36 months. Local control was achieved in 100% of patients. After surgery, 37.0% (n = 10) received adjuvant radiation alone and 33.3% (n = 9) of patients went on to receive adjuvant chemoradiation. On imaging, 72% (n = 18) of PET-CT scans correctly localized the primary tumor. CONCLUSIONS Occult head and neck primaries present a diagnostic challenge that is not adequately overcome using traditional detection protocols. The current study presents our unique protocol at Dalhousie University, which demonstrates the efficacy of the PET-CT TLM protocol from both a detection and therapeutic perspective. LEVEL OF EVIDENCE 4. Laryngoscope, 128:2307-2311, 2018.
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Affiliation(s)
- Victoria Kuta
- Faculty of Medicine, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Blair Williams
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Rigby
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Hart
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan Trites
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colin MacKay
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
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Moran S, Martinez-Cardús A, Boussios S, Esteller M. Precision medicine based on epigenomics: the paradigm of carcinoma of unknown primary. Nat Rev Clin Oncol 2017; 14:682-694. [PMID: 28675165 DOI: 10.1038/nrclinonc.2017.97] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Epigenetic alterations are a common hallmark of human cancer. Single epigenetic markers are starting to be incorporated into clinical practice; however, the translational use of these biomarkers has not been validated at the 'omics' level. The identification of the tissue of origin in patients with cancer of unknown primary (CUP) is an example of how epigenomics can be incorporated in clinical settings, addressing an unmet need in the diagnostic and clinical management of these patients. Despite the great diagnostic advances made in the past decade, the use of traditional diagnostic procedures only enables the tissue of origin to be determined in ∼30% of patients with CUP. Thus, development of molecularly guided diagnostic strategies has emerged to complement traditional procedures, thereby improving the clinical management of patients with CUP. In this Review, we present the latest data on strategies using epigenetics and other molecular biomarkers to guide therapeutic decisions involving patients with CUP, and we highlight areas warranting further research to engage the medical community in this unmet need.
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Affiliation(s)
- Sebastián Moran
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Avinguda Gran Via 199-203, 08908 L'Hospitalet del Llobregat, Barcelona, Spain
| | - Anna Martinez-Cardús
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Avinguda Gran Via 199-203, 08908 L'Hospitalet del Llobregat, Barcelona, Spain
| | - Stergios Boussios
- Department of Medical Oncology, Ioannina University Hospital, Niarxou Avenue, 45110 Ioannina, Greece
| | - Manel Esteller
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Avinguda Gran Via 199-203, 08908 L'Hospitalet del Llobregat, Barcelona, Spain.,Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Carrer de la Feixa Llarga, s/n, 08908 L'Hospitalet, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, 08010 Barcelona, Spain
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Burglin SA, Hess S, Høilund-Carlsen PF, Gerke O. 18F-FDG PET/CT for detection of the primary tumor in adults with extracervical metastases from cancer of unknown primary: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6713. [PMID: 28422888 PMCID: PMC5406105 DOI: 10.1097/md.0000000000006713] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cancer of unknown primary (CUP) is a heterogeneous group of cancers, so called when a biopsy from a patient reveals malignancy without giving a clue to where in the body the primary tumor is located. Whole-body 18-fluorine-fluorodeoxyglucose positron-emission-tomography/computed tomography (18F-FDG PET/CT) is widely used for diagnosis and staging of most cancers. We hypothesized that 18F-FDG PET/CT-especially if used early-is suitable for the detection of the primary tumor in patients with CUP. OBJECTIVE To assess the ability of 18F-FDG PET/CT to detect the primary tumor in adult CUP patients. DATA SOURCES PubMed/Medline, Embase, and Web of Science. STUDY ELIGIBILITY CRITERIA Studies on CUP from extracervical metastases in which every patient had received an 18F-FDG PET/CT scan and at least one 18F-FDG PET/CT-positive finding was confirmed by biopsy or clinical follow-up. STUDY APPRAISAL PRISMA and QUADAS-2 were applied. SYNTHESIS METHODS The pooled detection rate (DR) of 18F-FDG PET/CT was assessed with a fixed-effects model. Heterogeneity among studies was assessed with the I-squared statistic. RESULTS A total of 2953 articles were identified from which N = 82 were assessed by full text and N = 20, comprising 1942 adult patients, were included in the study. Median (range) number of patients and DR was N = 72 (21-316) and 36.3% (9.8%-75.3%), respectively. Two-thirds of included studies were retrospective, and the pooled DR was 40.93% (95% confidence interval: 38.99%-42.87%). There was large heterogeneity between studies (I-squared = 95.9%), randomization was not applied, CUP diagnosis was not standardized, and workup (if described) was characterized by multiple testing procedures resulting in a highly selected, challenging patient group. CONCLUSIONS Despite great heterogeneity in diagnostic workup and in studies in general, an overall DR of 40.93% suggests that upfront application of 18F-FDG PET/CT may have a role in CUP by obviating a great many futile diagnostic procedures. To what degree 18F-FDG PET/CT used early in the course of disease may improve the detection rate could not be deducted from selected articles. A large, prospective, preferably randomized, study on the potential benefit of using 18F-FDG PET/CT up front in CUP patients is warranted to judge if and when 18F-FDG PET/CT should be applied in these patients.
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Affiliation(s)
- Synne Alexandra Burglin
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark, Odense C
| | - Søren Hess
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark, Odense C
- Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark, Odense C
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital
- Centre of Health Economics Research, University of Southern Denmark, Odense M, Denmark
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Riaz S, Nawaz MK, Faruqui ZS, Saeed Kazmi SA, Loya A, Bashir H. Diagnostic Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in the Evaluation of Carcinoma of Unknown Primary. Mol Imaging Radionucl Ther 2016; 25:11-8. [PMID: 27299283 PMCID: PMC4807344 DOI: 10.4274/mirt.05706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Detection of primary tumor site in patients with carcinoma of unknown primary (CUP) syndrome has always been a diagnostic dilemma, necessitating extensive workup. Early detection of primary tumor site coupled with specific therapy improves prognosis. The low detection rate of the primary tumor site can be attributed to the biological behavior or the small size of the primary tumor to be detected by conventional imaging. The objective of this study was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in detecting CUP. Methods: A retrospective, cross-sectional analysis of 100 PET-CT scans of patients with CUP syndrome between November 2009 and December 2013 was performed. Eighteen patients whose final histopathology results could not be obtained for correlation were excluded from analysis. The hypermetabolic sites were assessed in correlation with histopathology. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive values were assessed for PET-CT. Results: Out of the 82 patients, primary tumor was correctly identified in 57.3% patients by 18F-FDG PET-CT (true positive). The PET-CT scan results were negative for primary site localization in 15% of patients (false negative). While 21% had true negative results, 7.3% displayed false positive results. PET-CT scan upstaged the disease in 27% cases. Overall, the diagnostic accuracy was found to be 78%, sensitivity 80%, specificity 74%, positive predictive value 88.7% and negative predictive value 59%. Conclusion: Our data supports the utility of 18F-FDG PET-CT scan in the localization and staging of CUP syndrome.
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Affiliation(s)
| | | | | | | | | | - Humayun Bashir
- Humayun Bashir MD, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Department of Nuclear Medicine, Lahore, Pakistan Phone: +92-42-36632182 E-mail:
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Kinder KJ, Lavertu P, Yao M. Positron Emission Tomography in Head and Neck Squamous Cell Carcinoma of Unknown Primary. PET Clin 2016; 7:443-52. [PMID: 27157650 DOI: 10.1016/j.cpet.2012.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article summarizes selected published studies on the use of FDG-PET and PET/CT in the workup of head and neck carcinoma of unknown primary (HNCUP). It shows that PET is a useful imaging modality in identification of the occult primary tumor and discovery of distant metastases. The results of PET often lead to a change in management in these patients. The limitations of PET in HNCUP are also discussed.
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Affiliation(s)
- Kimberly J Kinder
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Pierre Lavertu
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Tamam C, Tamam M, Mulazimoglu M. The Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Bone Lesions of Undetermined Origin. World J Nucl Med 2016; 15:124-9. [PMID: 27134563 PMCID: PMC4809153 DOI: 10.4103/1450-1147.176885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.
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Affiliation(s)
- Cuneyt Tamam
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
| | - Muge Tamam
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mulazimoglu
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
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YAYLALI O, KIRAÇ FS, YÜKSEL D. The role of 18F-FDG PET-CT in the detection of unknown primary malignancy: a retrospective study. Turk J Med Sci 2016; 46:474-82. [DOI: 10.3906/sag-1502-99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/01/2015] [Indexed: 11/03/2022] Open
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Role of 2-Fluoro-2-Deoxyglucose PET/Computed Tomography in Carcinoma of Unknown Primary. PET Clin 2015; 10:297-310. [DOI: 10.1016/j.cpet.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Winter MC, Haberkorn U, Kratochwil C. [Importance of nuclear medicine diagnostics in CUP syndrome]. Radiologe 2014; 54:134-9. [PMID: 24445408 DOI: 10.1007/s00117-013-2548-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CLINICAL/METHODICAL ISSUE The diagnostic work-up in patients with carcinoma of unknown primary (CUP) syndrome is extensive, highly time-consuming and cost-intensive and ultimately often fails to detect a primary site. STANDARD RADIOLOGICAL METHODS In this context chest X-ray and computed tomography (CT) have been used as standard imaging modalities in CUP syndrome. METHODOLOGICAL INNOVATIONS Since the introduction of positron emission tomography (PET) evaluation of tumor vitality has become possible. Furthermore, PET-CT hybrid scanners allow the combination of functional and morphological imaging. PERFORMANCE Several meta-analyses have reported an additional overall detection rate between 24.5 % and 44 % by either PET or PET-CT. Metastatic localization (cervical versus extracervical) did not influence the performance. The sensitivity was usually high (> 80 %) but specificity was moderate ranging from 68 % to 88 % at best. If mentioned, the results obtained by fluorodeoxyglucose (FDG)-PET significantly changed the clinical management in approximately one third of the patients studied. In a direct comparison with PET alone, PET-CT did not depict significantly more primary tumors but was able to reduce false positive findings. ACHIEVEMENTS To determine the real additional value of PET-CT in the diagnosis of CUP syndrome large prospective studies with more uniform inclusion criteria are needed. Despite the capabilities of FDG-PET-CT there is as yet no evidence that a potentially improved diagnostic algorithm is translated into a better patient outcome. PRACTICAL RECOMMENDATIONS Nevertheless, FDG-PET-CT should be performed in all CUP patients where conventional imaging failed to detect a primary site or the results are equivocal. In CUP patients with cervical lymph node metastases PET-CT should be carried out prior to panendoscopy to reduce the number of false negative biopsies.
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Affiliation(s)
- M C Winter
- Abteilung für Nuklearmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland,
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Deonarine P, Han S, Poon FW, de Wet C. The role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in the management of patients with carcinoma of unknown primary. Scott Med J 2013; 58:154-62. [PMID: 23960054 DOI: 10.1177/0036933013496958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Carcinoma of unknown primary is one of the ten most frequent cancers worldwide. Its median survival time is less than 10 months. Detecting primary tumour locations and/or occult metastatic lesions may inform definitive treatment and improve patients’ prognosis. We aimed to determine: (1) the sensitivity, specificity and accuracy of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography; (2) its detection rate of primary tumour locations and occult metastases and (3) factors associated with improved survival times. Methods We retrospectively reviewed all cases in the West of Scotland for the period 1 December 2007 to 31 May 2011 that met all our selection criteria: (1) diagnosis of carcinoma of unknown primary; (2) a thorough but negative ‘work-up’ and (3) 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography report. Statistical methods included frequencies, Kaplan-Meier graphs and log-rank tests to compare survival times. Results 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected primary tumour sites in 19/51 (37.3%) and occult metastases in 28/51 (54.9%) of eligible patients. Its sensitivity, specificity and accuracy were 79.2%, 70.4% and 74.5%, respectively; 20/51 (39.2%) patients died during the study period with a median survival of 8.4 months (range 21.4, SD ± 6.2). The number of metastatic locations was strongly associated with survival ( p = 0.002), but detection of a primary tumour site ( p = 0.174) or histopathology ( p = 0.301) was not. Conclusion 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected occult metastatic sites in the majority and a primary cancer location in a substantial minority of patients. Our results were comparable with international literature and may indicate that 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography have an early role to improve the accuracy of cancer staging and to optimise carcinoma of unknown primary management.
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Affiliation(s)
- P Deonarine
- Radiology Consultant, Radiology Department, Glasgow Royal Infirmary, UK
| | - S Han
- Consultant Physician, Glasgow Royal Infirmary, UK
- Consultant Physician, West of Scotland PET Centre, Gartnavel General Hospital, UK
| | - FW Poon
- Radiology Consultant, Radiology Department, Glasgow Royal Infirmary, UK
- Radiology Consultant, West of Scotland PET Centre, Gartnavel General Hospital, UK
| | - C de Wet
- Associate Adviser in Postgraduate GP Education, NHS Education for Scotland, UK
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Wang G, Wu Y, Zhang W, Li J, Wu P, Xie C. Clinical value of whole-body F-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with carcinoma of unknown primary. J Med Imaging Radiat Oncol 2012; 57:65-71. [PMID: 23374557 DOI: 10.1111/j.1754-9485.2012.02441.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 05/11/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of the study is to investigate the clinical value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in detecting the primary sites in patients with carcinoma of unknown primary (CUP). METHODS The reports of FDG PET/CT scans of 164 patients with CUP syndrome in consecutive 2589 patients referred to our department from January 2006 to June 2010 were retrospectively reviewed. The final results were obtained from the pathologic reports, other imaging modalities diagnoses and clinical follow-up data. RESULTS There were 142 cases in the results analysis, as 19 patients were lost to follow-up and three patients were excluded. FDG PET/CT successfully detected primary tumours in 67 (47.2%) out of 142 patients. Among this group, 53 were pathologically proved and 17 patients were confirmed by clinical follow-up. The primary sites of 38 (56.7%) were in lung, eight (11.9%) in nasopharynx and 13 (19.4%) in digestive system. Six patients were misdiagnosed by FDG PET/CT scan. FDG PET/CT could not detect the primary lesion in 66 patients, and three primary tumours were identified by conventional work-up after negative FDG PET/CT scan. The accuracy, sensitivity and specificity of FDG PET/CT scan in detecting the primary site in this study were 93.7%, 95.7% and 91.7%, respectively. FDG PET/CT scan changed the medical management of about 33.8% of 142 CUP patients. CONCLUSION FDG PET/CT whole-body imaging is a valuable tool in detecting the primary tumour of patients with CUP site.
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Affiliation(s)
- Guohui Wang
- Department of Medical Imaging and Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, China
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Zhao K, Luo XM, Zhou SH, Liu JH, Yan SX, Lu ZJ, Yang SY, Lin LL, Dong MJ. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography as an effective diagnostic workup in cervical metastasis of carcinoma from an unknown primary tumor. Cancer Biother Radiopharm 2012; 27:685-93. [PMID: 22834634 DOI: 10.1089/cbr.2011.1134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The purpose of this study is to assess the potential of ¹⁸F-fluorodeoxyglucose (¹⁸FDG) positron emission tomography/computed tomography (PET/CT) imaging for the diagnosis of cervical metastasis of carcinoma of an unknown primary tumor (CUP) and to determine whether the maximum standardized uptake value (SUV(max)) is a prognostic factor. METHODS Twenty-five consecutive patients with cervical metastasis of CUP were retrospectively analyzed by PET/CT between July 2007 and July 2011. RESULTS FDG PET/CT suggested a primary tumor in 21 out of 25 patients (84.0%). The sensitivity of FDG PET/CT in detecting the primary tumor was 73.3% (11 of 15), and the positive predictive value was 52.4% (11 of 21). The median follow-up duration of survival patients was 10.4 months (range: 0-30 months). The estimated 2-year overall survival rate of all patients was 50.0%. Univariate analyses did not reveal a significant difference in overall survival between the group of 11 patients identified by pathology and the 14 patients not identified by pathology (overall survival was 57.1% and 49.1%, respectively; p=0.468). The median SUV(max) was 7.6. In the log-rank test, patients with a low SUV(max) (≤ 7.0) in cervical lymph nodes had a significantly higher survival rate at 2 years (87.5% vs. 21.2%; p=0.007) than patients with a high SUV(max) (>7.0). CONCLUSIONS Although our study was inconclusive due to the small sample size, our results suggest that FDG PET/CT may be an effective diagnostic workup in the cervical metastasis of carcinoma from an unknown primary tumor (UPT). In the present study, SUV(max) of PET/CT in the cervical lymph node may serve as a prognostic factor of cervical metastasis of carcinoma from a UPT based on the limited number of patients. Further studies are needed to confirm these findings.
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Affiliation(s)
- Kui Zhao
- Department of PET Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Bone Metastasis From Thyroid Cancer Diagnosed by I-131 Whole-Body Scan Without Identifiable Lesion in the Thyroid. Clin Nucl Med 2011; 36:1033-5. [DOI: 10.1097/rlu.0b013e3182291acd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deron PB, Bonte KM, Vermeersch HF, Van de Wiele C. Lymph node metastasis of squamous cell carcinoma from an unknown primary in the upper and middle neck: Impact of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography. Cancer Biother Radiopharm 2011; 26:331-4. [PMID: 21711095 DOI: 10.1089/cbr.2010.0918] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the potential of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging for detection of the primary tumor and its impact on treatment planning in patients presenting with cancer of unknown primary and squamous cell carcinoma (SCC)-positive cervical lymph nodes of the upper and middle neck. METHODS The study population consisted of 18 consecutive patients with biopsy-proven SCC involving lymph nodes of the upper and middle neck region and negative conventional diagnostic procedures with regard to the location of the primary. All patients underwent FDG-PET/CT according to a standard procedure in search for the primary, unidentified tumor. RESULTS In none of the patients FDG-PET/CT was able to indicate a primary tumor localization. Although FDG-PET/CT did identify all sites of known lymph node involvement, neither additional sites of lymph node involvement nor sites of distant metastases were identified. Accordingly, FDG-PET/CT did not impact patient treatment planning. CONCLUSIONS In this series, including patients suffering from lymph node metastases by an SCC of unknown primary in the upper and middle neck, FDG-PET/CT was unable to identify a primary tumor. In addition, FDG-PET/CT did not modify the treatment planning in any of the patients studied.
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Affiliation(s)
- Philippe B Deron
- Department of Head and Neck Surgery, University Hospital Ghent, Belgium.
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Abstract
Carcinoma of unknown primary (CUP) is defined as histologically proven metastatic disease that, after a complete diagnostic work-up, yields no primary detectable tumor. CUP is one of the ten most frequent cancers, with overall poor outcome. Detection of the unknown primary tumor is of crucial importance in this scenario, since it might help to select and offer definitive treatment, which, in turn, may improve patient prognosis. Additional diagnostic work-up, usually consisting of a combination of several radiological and endoscopic investigations and serum tumor marker studies, can be time consuming, expensive, and pose a significant burden to the patient. The final diagnostic yield of these tests is often limited. Combined positron emission tomography/computed tomography (PET/CT), using the radiotracer (18)F-fluoro-2-deoxyglucose (FDG), may be of great value in the management of patients with CUP for the detection of primary tumors. This chapter gives a brief introduction to the syndrome of CUP, followed by an outline of the rationale, use, and utility of FDG-PET/CT in CUP, and concludes with a discussion on the challenges and future directions in the diagnostic management of patients with CUP.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Moller AKH, Loft A, Berthelsen AK, Damgaard Pedersen K, Graff J, Christensen CB, Perell K, Petersen BL, Daugaard G. 18F-FDG PET/CT as a diagnostic tool in patients with extracervical carcinoma of unknown primary site: a literature review. Oncologist 2011; 16:445-51. [PMID: 21427201 DOI: 10.1634/theoncologist.2010-0189] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Carcinoma of unknown primary (CUP) represents a heterogeneous group of metastatic malignancies for which no primary tumor site can be identified after extensive diagnostic workup. Failure to identify the primary site may negatively influence patient management. The aim of this review was to evaluate (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) as a diagnostic tool in patients with extracervical CUP. MATERIALS AND METHODS A comprehensive literature search was performed and four publications were identified (involving 152 patients) evaluating (18)F-FDG PET/CT in CUP patients with extracervical metastases. All studies were retrospective and heterogeneous in inclusion criteria, study design, and diagnostic workup prior to (18)F-FDG PET/CT. RESULTS (18)F-FDG PET/CT detected the primary tumor in 39.5% of patients with extracervical CUP. The lung was the most commonly detected primary tumor site (∼50%). The pooled estimates of sensitivity, specificity, and accuracy of (18)F-FDG PET/CT in the detection of the primary tumor site were 87%, 88%, and 87.5%, respectively. CONCLUSIONS The present review of currently available data indicates that (18)F-FDG PET/CT might contribute to the identification of the primary tumor site in extracervical CUP. However, prospective studies with more uniform inclusion criteria are required to evaluate the exact value of this diagnostic tool.
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Affiliation(s)
- Anne Kirstine Hundahl Moller
- Department of Oncology 5073, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
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Natoli C, Ramazzotti V, Nappi O, Giacomini P, Palmeri S, Salvatore M, Landriscina M, Zilli M, Natali PG, Tinari N, Iacobelli S. Unknown primary tumors. Biochim Biophys Acta Rev Cancer 2011; 1816:13-24. [PMID: 21371531 DOI: 10.1016/j.bbcan.2011.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/17/2011] [Accepted: 02/19/2011] [Indexed: 12/27/2022]
Abstract
An unknown primary tumor (UPT) is defined by the presence of a metastatic cancer without a known primary site of origin despite a standardized diagnostic workup. Clinically, UPTs show rapid progression and early dissemination, with signs and symptoms related to the metastatic site. The molecular bases of their biology remain largely unknown, with no evidence as to whether they represent a distinct biological entity. Immunohistochemistry remain the best diagnostic tool in term of cost-effectiveness, but the time-consuming "algorithmic process" it relies on has led to the application of new molecular techniques for the identification of the primary site of UPTs. For example, several microarray or miRNA classifications of UPTs have been used, with an accuracy in the prediction of the primary site as high as 90%. It should be noted that validating a prediction of tissue origin is challenging in these patients, since most of them will never have a primary site identified. Moreover, prospective studies to determine whether selection of treatment options based on such profiling methods actually improves patient outcome are still missing. In the last few years functional imaging (i.e. FDG-PET/CT) has gained a main role in the detection of the site of origin of UPTs and is currently recommended by the European Association of Nuclear Medicine. However, despite recent refinements in the diagnostic workup, the site of origin of UPT often remains elusive. As a consequence, treatment of patients with UPT is still empirical and inadequate.
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Affiliation(s)
- C Natoli
- Unit of Medical Oncology, Department of Oncology and Experimental Medicine and CeSI, Fondazione 'G. D' Annunzio', University of Chieti-Pescara, 66100 Chieti, Italy.
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Yanagawa T, Shinozaki T, Iizuka Y, Takagishi K, Watanabe H. Role of 2-deoxy-2-[F-18] fluoro-D-glucose positron emission tomography in the management of bone and soft-tissue metastases. ACTA ACUST UNITED AC 2010; 92:419-23. [PMID: 20190315 DOI: 10.1302/0301-620x.92b3.23131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively reviewed 71 histopathologically-confirmed bone and soft-tissue metastases of unknown origin at presentation. In order to identify the site of the primary tumour all 71 cases were examined with conventional procedures, including CT, serum tumour markers, a plain radiograph, ultrasound examination and endoscopic examinations, and 24 of the 71 cases underwent 2-deoxy-2-[F-18] fluoro-D-glucose positron emission tomography (FDG-PET). This detected multiple bone metastases in nine patients and the primary site in 12 of the 24 cases; conventional studies revealed 16 primary tumours. There was no significant difference in sensitivity between FDG-PET and conventional studies. The mean maximal standardised uptake value of the metastatic tumours was significantly higher than that of the primary tumours, which is likely to explain why FDG-PET did not provide better results. It was not superior to conventional procedures in the search for the primary site of bone and soft-tissue metastases; however, it seemed to be useful in the staging of malignancy.
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Affiliation(s)
- T Yanagawa
- Department of Orthopaedic Surgery, Gunma University School of Health Science, Gunma University Graduate School of Medicine, Gunma, Japan.
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Czernin J, Benz MR, Allen-Auerbach MS. PET/CT imaging: The incremental value of assessing the glucose metabolic phenotype and the structure of cancers in a single examination. Eur J Radiol 2010; 73:470-80. [PMID: 20097498 DOI: 10.1016/j.ejrad.2009.12.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/15/2009] [Indexed: 01/12/2023]
Abstract
PET/CT with the glucose analogue FDG is emerging as the most important diagnostic imaging tool in oncology. More than 2000 PET/CT scanners are operational worldwide and its unique role for diagnosing, staging, restaging and therapeutic monitoring in cancer is undisputed. Studies conducted in thousands of cancer patients have clearly indicated that the combination of molecular PET with anatomical CT imaging provides incremental diagnostic value over PET or CT alone. State of the art imaging protocols combine fully diagnostic CT scans with quality whole body PET surveys. The current review briefly describes the biological alterations of cancer cells that result in their switch to a strongly glycolytic phenotype. Different whole body imaging protocols are discussed. We summarize the evidence for the incremental value of PET/CT over CT and PET alone using imaging of sarcoma as an example. Following this section we discuss the performance of FDG-PET/CT imaging for staging, restaging and monitoring of head and neck cancer, solitary lung nodules and lung cancer, breast cancer, colorectal cancer, lymphoma and unknown primary tumors. Finally, the recently emerging evidence of a substantial impact of PET/CT imaging on patient management is presented.
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Affiliation(s)
- Johannes Czernin
- Department of Molecular and Medical Pharmacology, Ahmanson Biological, Imaging Center/Nuclear Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-6948, USA.
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The value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in carcinoma of an unknown primary: diagnosis and follow-up. Nucl Med Commun 2010; 31:59-66. [DOI: 10.1097/mnm.0b013e328332b340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kwee TC, Basu S, Cheng G, Alavi A. FDG PET/CT in carcinoma of unknown primary. Eur J Nucl Med Mol Imaging 2009; 37:635-44. [PMID: 19882152 PMCID: PMC2822231 DOI: 10.1007/s00259-009-1295-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 09/23/2009] [Indexed: 01/26/2023]
Abstract
Carcinoma of unknown primary (CUP) is a heterogeneous group of metastatic malignancies in which a primary tumor could not be detected despite thorough diagnostic evaluation. Because of its high sensitivity for the detection of lesions, combined 18F-fluoro-2-deoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) may be an excellent alternative to CT alone and conventional magnetic resonance imaging in detecting the unknown primary tumor. This article will review the use, diagnostic performance, and utility of FDG PET/CT in CUP and will discuss challenges and future considerations in the diagnostic management of CUP.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Tubiana-Hulin M, de Maulmont C, Guinebretière JM. Stratégie de prise en charge des métastases osseuses révélatrices. ONCOLOGIE 2009. [DOI: 10.1007/s10269-008-0981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lucić SM, Lucić MA, Peter A, Jovanović D, Vucaj-Cirilović V. [Positron emission tomography/computed tomography in patients with cancer of unknown primary origin]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:159-164. [PMID: 20420014 DOI: 10.2298/aci0904159l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED Cancer of unknown primary origin is not an uncommon clinical state, usually accounting for 2%-7% of all cancer patients. MATERIAL AND METHODS Positron emission tomography and computed tomography (PET/CT) was performed in 17 patients with histologically proven metastatic tumors of unknown primary and negative or inconclusive conventional diagnostic procedures. RESULTS The study included 17 patients (8 male and 9 female) age from 42 to 76 years. PET / CT has pointed out the probable localization of primary tumors in 10 patients. According histological diagnosis of carcinoma of unknown origin, most common is adenocarcinoma (64.71%). Origin of the primary cancer was found in 72.73% patients with adenocarcinoma 66.67% of respondents with squamocelular carcinoma and 50% of respondents with low differentiated carcinoma. Location of primary cancer was not found in 41.18% of the respondents, including patients with mucinous adenocarcinoma and patients with melanoma. CONCLUSION FDG PET/CT demonstrates very good whole-body imaging method in evaluation of patients with unknown primary carcinoma.
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Affiliation(s)
- S M Lucić
- Zavod za nuklearnu medicinu, Institut za onkologiju, Vojvodine, Sremska Kamenica
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Garin E, Lesimple T. Intérêt de la tomographie d’émission de positons au 18F-fluorodésoxyglucose (TEP-FDG) dans la prise en charge des syndromes CAPI. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol 2008; 19:731-44. [PMID: 18925401 PMCID: PMC2816234 DOI: 10.1007/s00330-008-1194-4] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 08/11/2008] [Accepted: 09/05/2008] [Indexed: 01/26/2023]
Abstract
The aim of this study was to systematically review and meta-analyze published data on the diagnostic performance of combined 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of primary tumors in patients with cancer of unknown primary (CUP). A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Methodological quality of the included studies was assessed. Reported detection rates, sensitivities and specificities were meta-analyzed. Subgroup analyses were performed if results of individual studies were heterogeneous. The 11 included studies, comprising a total sample size of 433 patients with CUP, had moderate methodological quality. Overall primary tumor detection rate, pooled sensitivity and specificity of FDG-PET/CT were 37%, 84% (95% CI 78–88%) and 84% (95% CI 78–89%), respectively. Sensitivity was heterogeneous across studies (P = 0.0001), whereas specificity was homogeneous across studies (P = 0.2114). Completeness of diagnostic workup before FDG-PET/CT, location of metastases of unknown primary, administration of CT contrast agents, type of FDG-PET/CT images evaluated and way of FDG-PET/CT review did not significantly influence diagnostic performance. In conclusion, FDG-PET/CT can be a useful method for unknown primary tumor detection. Future studies are required to prove the assumed advantage of FDG-PET/CT over FDG-PET alone and to further explore causes of heterogeneity.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Role of fluorodeoxyglucose-PET versus fluorodeoxyglucose-PET/computed tomography in detection of unknown primary tumor: a meta-analysis of the literature. Nucl Med Commun 2008; 29:666-73. [PMID: 18677207 DOI: 10.1097/mnm.0b013e328302cd26] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objectives of this study were to evaluate the diagnostic accuracy of fluorodeoxyglucose (FDG)-PET and FDG-PET/computed tomography (CT) in the detection of primary tumors in patients presenting with carcinoma of unknown primary (CUP) unidentified by conventional workup, and to compare the statistical difference between the FDG-PET and FDG-PET/CT. Twenty-eight studies (involving a total of 910 patients) published between 1990 and 2007 were reviewed. These studies evaluated the role of FDG-PET and FDG-PET/CT in the detection of unknown primary tumors after physical examination and conventional workup failed to detect a primary tumor. Systematic methods were used to identify, select, and evaluate the methodological quality of the studies as well as to summarize the overall findings of sensitivity, specificity, and detection capacity of the primary tumor. The overall sensitivity and specificity of FDG-PET in detecting unknown primary tumors were 0.78 [95% confidence interval (CI): 0.72-0.84)] and 0.79 (95% CI: 0.74-0.83), respectively. Furthermore, FDG-PET detected 28.54% of tumors that were not apparent after CUP failed to be detected by conventional workup. Data were collected on the locations of primary tumors detected by FDG-PET in 17 studies and detected by FDG-PET/CT in seven studies. Tumors from the base of the tongue accounted for 20.7% (six of 29) of all false-positive FDG-PET scans, corresponding to a false-positive rate of 28.6% (six of 29), much higher than tumors from the others. FDG-PET exhibited a lower sensitivity with respect to the tumors at the base of the tongue and tonsils, which was 68.2 and 76.7%, respectively. In the eight studies with 430 patients diagnosed with CUP by FDG-PET/CT, 31.4% (n=135) of primary tumors were detected. The pooled sensitivity and specificity were 0.81 (95% CI: 0.74-0.87) and 0.83 (95% CI: 0.78-0.87), respectively. FDG-PET and FDG-PET/CT can detect primary tumors that went undetected by physical examination and conventional workup. FDG-PET exhibited lower sensitivity with respect to the tumors at the base of the tongue and the tonsils.
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Tubiana-Hulin M, de Maulmont C, Guinebretière JM. Stratégie de prise en charge des métastases osseuses révélatrices. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.rhum.2008.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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