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Madani G, Arain Z, Awad Z. The radiological unknown primary of the head and neck: Recommendations for imaging strategies based on a systematic review. Clin Otolaryngol 2024; 49:16-28. [PMID: 37846889 DOI: 10.1111/coa.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To develop recommendations for the radiological investigation of clinically occult primary cancer in the head and neck. DESIGN AND SETTING In accordance with PRISMA guidelines, a search was performed on Medline, Embase and Cochrane library databases to investigate the efficacy of ultrasound guided Fine Needle Aspiration (US FNAC), contrast enhanced CT (CECT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose PET-CT (18F-FDG PET-CT) in the investigation of head and neck squamous cell carcinoma from an unknown primary (HNSCCUP) presenting with a metastatic cervical lymph node (s). The Quality Assessment of Diagnostic Accuracy Studies Version 2 tool and SIGN 50 guidelines were used to assess the risk of bias and quality of the included studies. PARTICIPANTS Adult patients presenting with metastatic cervical lymph nodes from a HNSCCUP. MAIN OUTCOME MEASURES Utility of different imaging modalities (PET-CT, MRI, CE CT and US FNAC in the management of HNSCCUP). RESULTS Twenty-eight studies met inclusion criteria; these were meta-analyses, systematic reviews, prospective and retrospective studies. CONCLUSIONS The optimal imaging strategy involves utilisation of various imaging modalities. US FNAC can provide the initial diagnosis and HPV status of the occult primary tumour. CECT and MRI detect up to 44% of occult tumours and guide management. FDG PET-CT is the most sensitive imaging modality for the detection of CUP and should be performed prior to panendoscopy.
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Affiliation(s)
- Gitta Madani
- Imperial College Healthcare NHS Trust, London, UK
| | - Zoya Arain
- Imperial College Healthcare NHS Trust, London, UK
| | - Zaid Awad
- Imperial College Healthcare NHS Trust, London, UK
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Real-Life Performance of F-18-FDG PET/CT in Patients with Cervical Lymph Node Metastasis of Unknown Primary Tumor. Biomedicines 2022; 10:biomedicines10092095. [PMID: 36140197 PMCID: PMC9495705 DOI: 10.3390/biomedicines10092095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Neoplasms in the head and neck region possess higher glycolytic activity than normal tissue, showing increased glucose metabolism. F-18-Flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can identify an unknown primary tumor (CUP). Aim: The aim of this study was to assess the real-life performance of F-18-FDG-PET/CT in detecting primary sites in patients with cervical lymph node metastasis of CUP. Methods: A retrospective data analysis of 31 patients who received FDG-PET/CT between June 2009 and March 2015 in a CUP context with histologically confirmed cervical lymph node metastasis was included. Results: In 48% of the patients (15/31), PET/CT showed suspicious tracer accumulation. In 52% of the patients (16/31), there was no suspicious radiotracer uptake, which was confirmed by the lack of identification of any primary tumor in 10 cases until the end of follow-up. FDG-PET/CT had a sensitivity of 67%, specificity of 91%, PPV of 92%, and NPV of 63% in detecting the primary tumor. Additionally, PET/CT showed suspicious tracer accumulation according to further metastasis in 32% of the patients (10/31). Conclusion: FDG-PET/CT imaging is a useful technique for primary tumor detection in patients in a cervical CUP context. Furthermore, it provides information on the ulterior metastasis of the disease.
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Zhu Y, Shen B, Pei X, Liu H, Li G. CT, MRI, and PET imaging features in cervical cancer staging and lymph node metastasis. Am J Transl Res 2021; 13:10536-10544. [PMID: 34650724 PMCID: PMC8507065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) fusion imaging technique features in cervical cancer staging and lymph node metastasis. METHODS A total of 196 cervical cancer patients undergoing CT, MRI, PET/CT, and PET/MRI preoperatively were enrolled. The diagnostic accuracy and detection rates for paracervical invasion were evaluated on the basis of the International Federation of Gynecology and Obstetrics (FIGO) staging classification for cervical cancer. The diagnostic efficacy of each examination modality for determining lymph node metastasis was evaluated using surgical pathology as a reference. The CT and MRI imaging features of lymph node metastasis were compared. RESULTS PET/MRI had a higher diagnostic accuracy for cervical cancer (94.90%) than PET/CT, MRI, and CT (83.67%, 75.51%, and 69.39%) (P < 0.05). PET/MRI showed a higher detection rate of vaginal invasion, uterine invasion, bladder invasion, and cervical invasion than PET/CT, MRI, and CT (P < 0.05). The metastasis group showed higher maximum long and short axis diameters and axial ratios than the non-metastasis group (P < 0.05). The metastasis group had higher wash-in rates (WIR), maximum relative enhancements (MRE), wash-out ratios (WOR), and apparent diffusion coefficients (ADC), and lower times to peak (TTP) than the non-metastasis group (P < 0.05). The sensitivity (94.74%), specificity (93.33%), and accuracy (93.88%) of PET/MRI in the diagnosis of cervical cancer lymph node metastasis were higher than the sensitivity, specificity, and accuracy of PET/CT, MRI and CT (P < 0.05). CONCLUSION CT, MRI, PET/CT and PET/MRI can be used effectively in the diagnosis of cervical cancer staging and lymph node metastasis, among which PET/MRI has a higher diagnostic sensitivity, specificity, and accuracy and is helpful in clinical diagnosis and treatment.
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Affiliation(s)
- Yongxiang Zhu
- Department of Gynecology, The Second People’s Hospital of RizhaoRizhao, Shandong Province, China
| | - Baomei Shen
- Department of Oncology, Binzhou Hospital of Traditional Chinese MedicineBinzhou, Shandong Province, China
| | - Xuan Pei
- Department of Gynecology, Binzhou People’s HospitalBinzhou, Shandong Province, China
| | - Haixia Liu
- Special Examination Department, Taian Maternal and Child Health HospitalTaian, Shandong Province, China
| | - Guoyan Li
- Department of Medical Imaging, Laizhou City People’s HospitalLaizhou, Shandong Province, China
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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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The Additional Value of Ultrafast DCE-MRI to DWI-MRI and 18F-FDG-PET to Detect Occult Primary Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12102826. [PMID: 33007978 PMCID: PMC7600235 DOI: 10.3390/cancers12102826] [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: 08/26/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Patients with cervical lymph node metastasis from squamous cell carcinoma undergo extensive irradiation or surgery of the head and neck with higher treatment morbidity, recurrence rate and lower overall survival than patients with overt primary tumor. In order to enhance treatment efficiency and morbidity reduction, the primary tumor detection accuracy was evaluated by using Ultrafast-Dynamic Contrast-Enhancement (DCE-)MRI in addition to Diffusion-Weighted (DW-)MRI and 18F-FDG-PET/CT imaging. Ultrafast-DCE, with a temporal resolution of 4 s, enabled capturing lesions with increased neoangiogenesis or perfusion compared to normal tissue. The use of Ultra-fast DCE resulted in higher confidence for suspicious locations and high observer agreement. Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity. Abstract To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ultrafast-DCE, DWI or 18F-FDG-PET and the combination of modalities for the detection of unknown primary tumor (UPT) in patients presenting with cervical lymph node metastasis from squamous cell carcinoma (SCC). Between 2014–2019, patients with histologically proven cervical lymph node metastasis of UPT SCC were prospectively included and underwent DWI, ultrafast-DCE, and 18F-FDG-PET/CT. Qualitative assessment was performed by two observers per modality. Interobserver agreement was calculated using the proportion specific agreement. Diagnostic accuracy of combined use of DWI, ultrafast-DCE and 18F-FDG-PET/CT was assessed. Twenty-nine patients were included (20 males. [68%], median age 60 years). Nine (31%) primary tumors remained occult. Ultrafast-DCE added reader confidence for suspicious locations (one additional true positive (5%), 2 decisive true malignant (10%). The per-location analysis showed highest specific positive agreement for ultrafast-DCE (77.6%). The per-location rating showed highest sensitivity (95%, 95%CI = 75.1–99.9, YI = 0.814) when either one of all modalities was scored positive, and 97.4% (95%CI = 93.5–99.3, YI = 0.774) specificity when co-detected on all. The per-patient analysis showed highest sensitivity (100%) for 18F-FDG-PET/CT (YI = 0.222) and either DWI or PET (YI = 0.111). Despite highest trends, no significant differences were found. The per-patient analysis showed highest specific positive agreement when co-detected on all modalities (55.6%, 95%CI = 21.2–86.3, YI = 0.456). Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity.
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Maghami E, Ismaila N, Alvarez A, Chernock R, Duvvuri U, Geiger J, Gross N, Haughey B, Paul D, Rodriguez C, Sher D, Stambuk HE, Waldron J, Witek M, Caudell J. Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head and Neck: ASCO Guideline. J Clin Oncol 2020; 38:2570-2596. [PMID: 32324430 DOI: 10.1200/jco.20.00275] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing physicians and other health care providers on the diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck (SCCUP). METHODS The American Society of Clinical Oncology convened an Expert Panel of medical oncology, surgery, radiation oncology, radiology, pathology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2008 through 2019. Outcomes of interest included survival, local and regional disease control, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 100 relevant studies to inform the evidence base for this guideline. Four main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate pathology techniques, and adjuvant therapy. RECOMMENDATIONS Evidence-based recommendations were developed to address preoperative evaluation for patients with a neck mass, surgical diagnostic and therapeutic procedures, appropriate treatment options in unilateral versus bilateral SCCUP.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce Haughey
- Advent Health Medical Group, Otolaryngology, Head and Neck Surgery, Celebration, FL, and University of South Florida, Tampa, FL
| | - Doru Paul
- Weill Cornell Medical College, New York, NY
| | | | - David Sher
- University of Texas Southwestern, Dallas, TX
| | | | - John Waldron
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Matt Witek
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Cystic form of cervical lymphadenopathy in adults. Guidelines of the French Society of Otorhinolaryngology (short version). Part 2–etiological diagnosis procedure: Clinical and imaging assessment. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:117-121. [DOI: 10.1016/j.anorl.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Qaseem A, Usman N, Jayaraj JS, Janapala RN, Kashif T. Cancer of Unknown Primary: A Review on Clinical Guidelines in the Development and Targeted Management of Patients with the Unknown Primary Site. Cureus 2019; 11:e5552. [PMID: 31695975 PMCID: PMC6820325 DOI: 10.7759/cureus.5552] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Cancer of unknown primary (CUP) is a malignant widespread metastatic disease without an identifiable primary site after extensive clinical investigation. Recently, a decline is observed in the diagnosis of CUP, mainly due to improvement in detection of the primary tumors, thus decreasing the unknown primaries. Worldwide, CUP is the sixth to eighth most common malignancy, accounting for 2.3% to 5% of a new cancer diagnosis. CUP is third to fourth most common cause of death due to cancer-related mortality. The prognosis of CUP is depressing with the median survival of three to six months in the previous studies, but according to recent studies, median survival is less than one year. High risk for developing CUP is seen in heavy smokers (26 or more cigarettes/day) and individuals with the lowest quartiles of waist circumference. A weak association is observed with the use of alcohol consumption and low level of education. Human papillomavirus DNA plays a role in those with squamous cell carcinoma of unknown primaries in head and neck regions. In the diagnosis of CUP, comprehensive medical history, complete physical examination (including genitourinary, rectal exam, and breast examination in women) and necessary laboratory tests are crucial. Whole-body positron emission tomography-computed tomography (PET/CT) is the investigation of choice to assess the entire body for CUP. Multiparametric 3T-MRI (MP-MRI) is used to examine the local soft tissue status, helps in the staging of the tumor, and to determine the extent of involvement of tissue for medical as well as prognostic purposes. Immunohistochemistry outlines the specific markers, including caudal-related homeobox protein (CDX2), homeobox protein Nkx-3.1 (NKX3-1), paired box gene 8 (PAX8), special AT-rich sequence-binding protein 2 (SATB2), thyroid transcription factor 1 (TTF-1), and splicing factor 1 (SF1) with the focus on the effectiveness of lineage-restricted transcription factors. Patients response to treatment can be evaluated by the gene expression profiling (GEP) test that also predicts tissue of origin (TOO). Tumor identified through gene profiling is sensitive to platinum/taxane therapy, others that are not TOO tumors are resistant to platinum/taxane. The new therapeutic method based on molecular profiling is associated with higher treatment response. In comprehensive genomic profiling, it is observed that there is at least one clinically appropriate genomic alteration in CUP that can influence the targeted therapy. The targeted therapeutic approach will not only improve the disease outcome but will also be cost-effective and save time from finding the primary site.
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Affiliation(s)
- Aisha Qaseem
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Norina Usman
- Internal Medicine, Veterans Affairs Palo Alto Health Care System - Stanford University School of Medicine, Palo Alto, USA
| | - Joseph S Jayaraj
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Rajesh Naidu Janapala
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
| | - Tooba Kashif
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Diagnostic value of diffusion-weighted imaging and 18F-FDG-PET/CT for the detection of unknown primary head and neck cancer in patients presenting with cervical metastasis. Eur J Radiol 2018; 107:20-25. [PMID: 30292267 DOI: 10.1016/j.ejrad.2018.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/05/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Head and neck squamous cell carcinoma (HNSCC) may present with cervical metastases without an apparent primary tumor. Detecting the primary tumor results in more targeted treatment. Acquisition of DWI is improving with less artifacts and image distortion. We assessed the diagnostic value of DWI and 18F-FDG-PET/CT for detecting primary tumors in patients presenting with nodal metastasis of an unknown primary HNSCC. MATERIALS AND METHODS For this retrospective study we included 31 patients (male/female ratio = 23/8, median age = 66 years, age range = 40-80 years) who presented with a pathologically proven cervical nodal metastasis from HNSCC without overt primary tumor location between January 2013 and November 2016 and underwent both DWI and 18F-FDG-PET/CT. Both modalities were assessed qualitatively and quantitatively. With ROC analysis we determined the optimal cut-off for imaging parameters in separating occult malignancy from benign tissue. RESULTS Qualitative analysis of MRI including DWI resulted in a sensitivity of 81.3% (95%CI) = 53.7-95.0) and specificity of 73.3% (95%CI = 44.8-91.1). With qualitative scoring of 18F-FDG-PET/CT a sensitivity and specificity of 93.8% (95%CI = 67.8-99.7) and 73.3% (95%CI = 44.8-91.1) were found. With quantitative analysis sensitivity and specificity of SUVmax were 81.3% (95%CI = 53.6-95.0) and 93.3% (95%CI = 66.0-99.7), respectively. Combining DWI and 18F-FDG-PET/CT resulted in a sensitivity of 93.8% (95%CI = 67.7-99.7%) and specificity of 60.0% (95%CI = 32.9-82.5%). CONCLUSION In this study on HNSCC patients presenting with clinically UP lesions the diagnostic accuracy of qualitative analysis with DWI and 18F-FDG-PET/CT and quantitative analysis of 18F-FDG-PET/CT using SUVmax were high. Adding DWI did not improve the accuracy of 18F-FDG-PET/CT.
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Sookha RR, Zhi W, Shen Y, Lazare C, Wang L, Meng Y, Cao C, Hu J, Wu P. Clinical Value of Combining 18F-FDG PET/CT and Routine Serum Tumor Markers in The Early Detection of Recurrence Among Follow-up Patients Treated for Cervical Squamous Cell Carcinoma. J Cancer 2018; 9:3101-3108. [PMID: 30210633 PMCID: PMC6134808 DOI: 10.7150/jca.27206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/28/2018] [Indexed: 01/27/2023] Open
Abstract
Objective: The purpose of this retrospective study was to investigate the role of 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET/CT) and evaluate if combined elevated serum tumor markers levels improve the accuracy of 18F-FDG PET/CT in detecting recurrence of cervical squamous cell carcinoma. Methods: A total number of 42 patients who were treated for cervical squamous cell carcinoma and had underwent 18F-FDG PET/CT for suspected recurrence of cervical cancer were retrospectively reviewed in this study and their clinical, pathological and serological data were collected and analyzed. The clinical value of combining 18F-FDG PET/CT with serum tumor markers was investigated. Results: Among the 42 patients, 18F-FDG PET/CT was true positive in 25 (59.5%), false positive in 5 (11.9%), true negative in 12 (28.5%) and false negative in none. The overall patient-based sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 18F-FDG PET/CT in detecting recurrent cervical cancer were 100%, 70.6, 88.1%, 83.3%, and 100%, respectively. The accuracy of 18F-FDG PET/CT with combined squamous cell carcinoma antigen (SCC Ag) and carcinoembryonic antigen (CEA) elevation was 100% compared to only SCC Ag elevation and only CEA elevation, 90% and 33.3%, respectively. The positive predictive value of a positive 18F-FDG PET/CT with combined SCC Ag and CEA elevation was 100% for detection of recurrent cervical cancer. Also, the negative predictive value of a negative 18F-FDG PET/CT combined with normal SCC Ag and CEA levels was 100%. Conclusion:18F-FDG PET/CT is highly sensitive in the diagnosis of recurrent cervical cancer. When 18F-FDG PET/CT is associated with both SCC Ag and CEA elevation or only SCC Ag elevation, the accuracy is increased but not when associated with only CEA elevation. Positive 18F-FDG PET/CT associated with both tumor markers elevation can precisely predict recurrence. Moreover, normal levels of both tumor markers with a negative 18F-FDG PET/CT result may clinically reassure that a recurrence is absent.
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Affiliation(s)
- Rajiv Rai Sookha
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Wenhua Zhi
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Yanxia Shen
- Department of Nuclear medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Cordelle Lazare
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Ling Wang
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Yifan Meng
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Canhui Cao
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Junbo Hu
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Peng Wu
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
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Filauro M, Paderno A, Perotti P, Marchi F, Garofolo S, Peretti G, Piazza C. Role of narrow-band imaging in detection of head and neck unknown primary squamous cell carcinoma. Laryngoscope 2018; 128:2060-2066. [DOI: 10.1002/lary.27098] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/27/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Marta Filauro
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Sabrina Garofolo
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, Italian Research Hospital Foundation, National Cancer Institute of Milan; University of Milan; Milan Italy
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