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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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Koch WM. Clinical features of HPV-related head and neck squamous cell carcinoma: presentation and work-up. Otolaryngol Clin North Am 2013; 45:779-93. [PMID: 22793852 DOI: 10.1016/j.otc.2012.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) that arises as a result of the activity of human papillomavirus (HPV) malignant transformation has a distinct disease pattern that is the basis for its clinical presentation. A clear understanding of these distinct clinical features enables diagnosticians to maintain awareness and index of suspicion to avoid delays in detection and select the most effective and thorough measures of evaluating the disease and directing treatment selection. Attention is focused on the broader demographic at risk for developing HPV-related HNSCC, the phenomenon of cystic cervical nodal metastases, and the unknown or occult primary cancer.
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Affiliation(s)
- Wayne M Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA.
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Talavera-Rubio MDP, García-Vicente AM, Palomar-Muñoz AM, Pilkington-Woll JP, Poblete-García VM, Soriano-Castrejón A. [Usefulness of (18)F-fluorodeoxyglucose-positron emission tomography-computerized tomography in the identification of the primary tumor in patients with cancer of unknown origin]. Med Clin (Barc) 2013. [PMID: 23177314 DOI: 10.1016/j.medcli.2012.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE We determined the utility of the (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)-computerized tomography (CT) in the localization of the primary tumor in patients with tumor of unknown origin (TUO). PATIENTS AND METHOD (18)F-FDG PET-CT scans, performed between November 2006 and November 2010, in search for the primary tumor in patients with TUO, were retrospectively evaluated. Patients underwent a standard PET-CT, 50-60minutes after intravenous injection of 296-370MBq (18)F-FDG. PET-CT studies were assessed as pathological, with/without identification of the primary tumour and no pathological. Final diagnosis was established by histological confirmation and/or clinical/radiologic follow-up longer than 6 months. RESULTS We studied 74 patients (59 males, 15 females), with ages ranging from 41-89 years. In 38 (51%) patients the PET-CT assessed the correct origin of the primary tumour. In 8 cases, a histological confirmation in the primary lesion was obtained. In 4 patients the PET-CT showed a false positive result. CONCLUSION PET-CT scanning identified 51% of the primary sites in our sample of patients.
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Wong WL, Sonoda LI, Gharpurhy A, Gollub F, Wellsted D, Goodchild K, Lemon C, Farrell R, Saunders M. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers--an audit and review of published studies. Clin Oncol (R Coll Radiol) 2011; 24:190-5. [PMID: 22183080 DOI: 10.1016/j.clon.2011.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 10/05/2011] [Accepted: 11/04/2011] [Indexed: 02/07/2023]
Abstract
AIMS To assess the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with squamous cell and undifferentiated cancer neck nodes and no primary site on conventional assessment. MATERIALS AND METHODS Seventy-eight patients with neck nodal metastases from an unknown primary cancer were studied. PET/CT was carried out in all patients, 1h after FDG injection. RESULTS Uptake suspicious of an occult primary cancer was found in 46/78 (59.0%) patients. Subsequent investigations confirmed a primary site in the base of the tongue in 14, pharyngeal palatine tonsil in 14, post cricoid in one, lung in one. PET/CT diagnosed primary cancers in 30/78 patients (38.5%); sensitivity, specificity, positive predictive value, negative predictive value: 30/30 (100.0%), 32/48 (66.7%), 30/46 (65.2%), 32/32 (100.0%), respectively. PET/CT detected additional disease in four patients: contralateral nodal disease in two, mediastinal nodal disease in one and liver metastases in one. CONCLUSIONS FDG PET/CT is of value in the assessment of patients with occult head and neck primary cancers. However, false-positive results remain a limitation of the investigation.
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Affiliation(s)
- W L Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK.
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Bhatia KSS, King AD, Yeung DKW, Mo F, Vlantis AC, Yu KH, Wong JKT, Ahuja AT. Can diffusion-weighted imaging distinguish between normal and squamous cell carcinoma of the palatine tonsil? Br J Radiol 2010; 83:753-8. [PMID: 20647507 DOI: 10.1259/bjr/58331222] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The utility of diffusion-weighted imaging (DWI) in the detection of squamous cell carcinoma (SCC) of the tonsils has not been previously investigated. This preliminary study compared DWI of apparent SCC tonsillar tumours with normal tonsils. DWI of the tonsils was performed in 10 patients with newly diagnosed tonsil SCC that was evident on conventional MRI and in 17 patients undergoing cranial MRI for other indications. Regions of interest (ROI) were drawn around each identifiable tonsil on the apparent diffusion coefficient (ADC) map and the mean ADC value for each tonsil was calculated. ADC values for normal and SCC tonsils were compared using the Mann-Whitney U-test. The median ADC and range (x10(-3) mm(2) s(-1)) were found to be 0.814 and 0.548-1.312, respectively, for normal tonsils compared with 0.933 and 0.789-1.175, respectively, for SCC tonsils. ADC values were significantly higher for SCC tonsils than for normal tonsils (p = 0.009). No SCC tonsil had an ADC less than 0.82 x 10(-3) mm(2) s(-1) compared with 58% of normal tonsils. We conclude that there is a difference in the ADC between normal tonsils and SCC tonsils where the cancer is apparent on conventional MRI. These results are promising, although further studies are now required to determine whether DWI can be used to identify or exclude smaller foci of SCC within tonsils where the cancer is not evident on conventional MRI.
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Affiliation(s)
- K S S Bhatia
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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Diagnosis and treatment of a neck node swelling suspicious for a malignancy: an algorithmic approach. Int J Surg Oncol 2010; 2010:581540. [PMID: 22312490 PMCID: PMC3265261 DOI: 10.1155/2010/581540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 03/27/2010] [Indexed: 12/03/2022] Open
Abstract
Aim. To present an up-to-date algorithm incorporating recent advances regarding its diagnosis and treatment. Method. A Medline/Pubmed search was performed to identify relevant studies published in English from 1990 until 2008. Only clinical studies were identified and were used as basis for the diagnostic algorithm. Results. The eligible literature provided only observational evidence. The vast majority of neck nodes from occult primaries (>90%) represent SCC with a high incidence among middle aged man. Smoking and alcohol abuse are important risk factors. Asiatic and North African patients with neck node metastases are at risk of harbouring an occult nasopharyngeal carcinoma. The remainder are adenocarcinoma, undifferentiated carcinoma, melanoma, thyroid carcinoma and Merkel cell carcinoma. Fine needle aspiration cytology (FNAC) reaches sensitivity and specificity percentages of 81% and 100%, respectively and plays an important role as the second diagnostic step after routine ENT mirror and/or endoscopic examination. FDG-PET/CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases. Conclusion. Although reports on the diagnostic process offer mainly descriptive studies, current information seems sufficient to formulate a diagnostic algorithm to contribute to a more systematic diagnostic approach preventing unnecessary steps.
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Al-Ibraheem A, Buck A, Krause BJ, Scheidhauer K, Schwaiger M. Clinical Applications of FDG PET and PET/CT in Head and Neck Cancer. JOURNAL OF ONCOLOGY 2009; 2009:208725. [PMID: 19707528 PMCID: PMC2730473 DOI: 10.1155/2009/208725] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Accepted: 06/17/2009] [Indexed: 01/26/2023]
Abstract
18F-FDG PET plays an increasing role in diagnosis and management planning of head and neck cancer. Hybrid PET/CT has promoted the field of molecular imaging in head and neck cancer. This modality is particular relevant in the head and neck region, given the complex anatomy and variable physiologic FDG uptake patterns. The vast majority of 18F-FDG PET and PET/CT applications in head and neck cancer related to head and neck squamous cell carcinoma. Clinical applications of 18F-FDG PET and PET/CT in head and neck cancer include diagnosis of distant metastases, identification of synchronous 2nd primaries, detection of carcinoma of unknown primary and detection of residual or recurrent disease. Emerging applications are precise delineation of the tumor volume for radiation treatment planning, monitoring treatment, and providing prognostic information. The clinical role of 18F-FDG PET/CT in N0 disease is limited which is in line with findings of other imaging modalities. MRI is usually used for T staging with an intense discussion concerning the preferable imaging modality for regional lymph node staging as PET/CT, MRI, and multi-slice spiral CT are all improving rapidly. Is this review, we summarize recent literature on 18F-FDG PET and PET/CT imaging of head and neck cancer.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Bernd Joachim Krause
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Klemens Scheidhauer
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
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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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Abstract
Squamous cell carcinoma is the most frequent malignancy of the head and neck region, accounting for 5% of all malignant tumors worldwide. Accurate staging at diagnosis is critical for selection of appropriate treatment strategy. A variety of therapeutic options are used for treatment, including surgery with or without radical dissection, lymph node dissections of various severities, radiotherapy, chemotherapy, and combinations of these. Precise prediction of the extent of primary tumors, detection of unknown primary tumor, cervical lymph node status, and distant metastatic spread is important for treatment planning and prognosis. Accurate evaluation of these factors prior to treatment helps guide surgical extent or radiation porta, minimizing locoregional treatment failure.
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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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Kothari P, Randhawa PS, Farrell R. Role of tonsillectomy in the search for a squamous cell carcinoma from an unknown primary in the head and neck. Br J Oral Maxillofac Surg 2008; 46:283-7. [DOI: 10.1016/j.bjoms.2007.11.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2007] [Indexed: 11/16/2022]
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