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The added value of 18F-fluorodeoxyglucose positron emission tomography computed tomography in patients with neck lymph node metastases from an unknown primary malignancy

Published online by Cambridge University Press:  07 August 2013

S J B Prowse ,
R Shaw ,
D Ganeshan ,
P M Prowse ,
R Hanlon ,
H Lewis-Jones  and
H Wieshmann
S J B Prowse*
Affiliation:
Department of Radiology, University Hospital Aintree, Liverpool, UK
R Shaw
Affiliation:
Department of Head and Neck Surgery, University Hospital Aintree, Liverpool, UK Department of Molecular and Clinical Cancer Medicine and Liverpool Cancer Research UK Centre, University of Liverpool, UK
D Ganeshan
Affiliation:
Department of Radiology, University Hospital Aintree, Liverpool, UK
P M Prowse
Affiliation:
Department of Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
R Hanlon
Affiliation:
Department of Radiology, University Hospital Aintree, Liverpool, UK
H Lewis-Jones
Affiliation:
Department of Radiology, University Hospital Aintree, Liverpool, UK
H Wieshmann
Affiliation:
Department of Radiology, University Hospital Aintree, Liverpool, UK
*
Address for correspondence: Dr S J B Prowse, Radiology Department, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK Fax: +44 151 529 3306 E-mail: sjbprowse@gmail.com
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Abstract

Background:

The search for a primary malignancy in patients with a metastatic cervical lymph node is challenging yet ultimately of utmost clinical importance. This study evaluated the efficacy of positron emission tomography computed tomography in detecting the occult primary, within the context of a tertiary referral centre head and neck cancer multidisciplinary team tumour board meeting.

Methods:

Thirty-two patients (23 men and 9 women; mean and median age, 61 years) with a metastatic cervical lymph node of unknown primary origin, after clinical examination and magnetic resonance imaging, underwent positron emission tomography computed tomography.

Results:

The primary tumour detection rate was 50 per cent (16/32). Positron emission tomography computed tomography had a sensitivity of 94 per cent (16/17) and a specificity of 67 per cent (10/15). Combining these results with those of 10 earlier studies of similar patients gave an overall detection rate of 37 per cent.

Conclusion:

Positron emission tomography computed tomography has become an important imaging modality. To date, it has the highest primary tumour detection rate, for head and neck cancer patients presenting with cervical lymph node metastases from an unknown primary.

Keywords

Positron-Emission Tomography and Computed TomographyHead and Neck NeoplasmsNeoplasms, Unknown PrimaryNeoplasm MetastasisDiagnostic Imaging

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 8 , August 2013 , pp. 780 - 787
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Muir, C. Cancer of an unknown primary site. Cancer 1995;75:353–63.0.CO;2-P>CrossRefGoogle Scholar
2Wartski, M, Le Stanc, E, Gontier, E, Vilain, D, Banal, A, Tainturier, C et al. In search of an unknown primary tumor presenting with cervical metastases: performance of hybrid FDG-PET-CT. Nucl Med Commun 2007;28:365–71CrossRefGoogle ScholarPubMed
3Pavlidis, N, Fizazi, K. Cancer of unknown origin. Crit Rev Oncol Hematol 2005;54:243–50CrossRefGoogle Scholar
4Glynne-Jones, RG, Anand, AK, Young, TE, Berry, RJ. Metastatic squamous cell carcinoma in the cervical lymph nodes from an occult primary. A conservative approach to the role of radiotherapy. Int J Radiat Oncol 1990;18:289–94CrossRefGoogle Scholar
5Schache, AG, Liloglou, T, Risk, JM, Filia, A, Jones, TM, Shaw, RJ et al. Evaluation of human papilloma virus diagnostic testing in oropharyngeal squamous cell carcinoma: sensitivity, specificity, and prognostic discrimination. Clin Cancer Res 2011;17:6262–71CrossRefGoogle ScholarPubMed
6Shaw, RJ, Robinson, M. The increasing clinical relevance of human papillomavirus type 16 (HPV-16) infection in oropharyngeal cancer. Br J Oral Maxillofac Surg 2011;49:423–9CrossRefGoogle ScholarPubMed
7SPH: Profile of Head and Neck Cancers in England. http://sph.fry-it.com/what-we-do/health-intelligence/publications/profile-of-head-and-neck-cancers-in-england [22 November 2011]Google Scholar
8Warburg, O, Posener, K, Negelein, E. On the metabolism of cancer cells. Biochem Z 1924;152:319–44Google Scholar
9Gambhir, SS, Czernin, J, Schwimmer, J, Silverman, DH, Coleman, RE, Phelps, ME. A tabulated summary of the FDG PET literature. J Nucl Med 2001;42(suppl 5):1–93SGoogle ScholarPubMed
10Deron, 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;26:331–4Google ScholarPubMed
11Park, JS, Yim, JJ, Kang, WJ, Chung, JK, Yoo, CG, Kim, YW et al. Detection of primary sites in unknown primary tumors using FDG-PET or FDG-PET/CT. BMC Res Notes 2011;4:56CrossRefGoogle ScholarPubMed
12Keller, F, Psychogios, G, Linke, R, Lell, M, Kuwert, T, Iro, H et al. Carcinoma of unknown primary in the head and neck: comparison between positron emission tomography (PET) and PET/CT. Head Neck 2011;33:1569–75CrossRefGoogle ScholarPubMed
13Waltonen, JD, Ozer, E, Hall, NC, Schuller, DE, Agrawal, A. Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup. Arch Otolaryngol Head Neck Surg 2009;135:1024–9CrossRefGoogle ScholarPubMed
14Roh, JL, Kim, JS, Lee, JH, Cho, KJ, Choi, SH, Nam, SY et al. Utility of combined (18)F-fluorodeoxyglucose-positron emission tomography and computed tomography in patients with cervical metastases from unknown primary tumors. Oral Oncol 2009;45:218–24CrossRefGoogle ScholarPubMed
15Nassenstein, K, Veit-Haibach, P, Stergar, H, Gutzeit, A, Freudenberg, L, Kuehl, H et al. Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography. Acta Radiol 2007;23:1–8Google Scholar
16Syed, R, Bomanji, JB, Nagabhushan, N, Hughes, S, Kayani, I, Groves, A et al. Impact of combined (18)F-FDG PET/CT in head and neck tumours. Br J Cancer 2005;92:1046–50CrossRefGoogle ScholarPubMed
17Freudenberg, LS, Fischer, M, Antoch, G, Jentzen, W, Gutzeit, A, Rosenbaum, SJ et al. Dual modality of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in patients with cervical carcinoma of unknown primary. Med Princ Pract 2005;14:155–60CrossRefGoogle ScholarPubMed
18Gutzeit, A, Antoch, G, Kühl, H, Egelhof, T, Fischer, M, Hauth, E et al. Unknown primary tumors: detection with dual modality PET/CT Initial experience. Radiology 2005;234:227–34CrossRefGoogle ScholarPubMed
19Haas, I, Hoffmann, TK, Engers, R, Ganzer, U. Diagnostic strategies in cervical carcinoma of an unknown primary (CUP). Eur Arch Otorhinolaryngol 2002;259:325–33CrossRefGoogle ScholarPubMed
20Adams, S, Baum, RP, Stuckensen, T, Bitter, K, Hör, G. Prospective comparison of 18F-FDG PET with conventional imaging techniques (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 1998;25:1255–60CrossRefGoogle Scholar
21Kau, RJ, Alexiou, C, Laubenbacher, C, Werner, M, Schwaiger, M, Arnold, W. Lymph node detection of head and neck squamous cell carcinomas by positron emission tomography with fluorodeoxyglucose F 18 in a routine clinical setting. Arch Otolaryngol Head Neck Surg 1999;125:1322–8CrossRefGoogle Scholar
22Kostakoglu, L, Goldsmith, SJ. PET in the assessment of therapy response in patients with carcinoma of the head and neck and of the esophagus. J Nucl Med 2004;45:56–68Google ScholarPubMed
23Goerres, GW, Schmid, DT, Bandhauer, F, Huguenin, PU, von Schulthess, GK, Schmid, S et al. Positron emission tomography in the early follow-up of advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 2004;130:105–9CrossRefGoogle ScholarPubMed
24Kole, AC, Nieweg, OE, Pruim, J, Hoekstra, HJ, Koops, HS, Roodenburg, JL et al. Detection of unknown occult primary tumors using positron emission tomography. Cancer 1998;82:1160–63.0.CO;2-3>CrossRefGoogle ScholarPubMed
25Hanasono, MM, Kunda, LD, Segall, GM, Ku, GH, Terris, DJ. Uses and limitations of FDG positron emission tomography in patients with head and neck cancer. Laryngoscope 1999;109:880–5CrossRefGoogle ScholarPubMed
26Bohuslavizki, KH, Klutmann, S, Kröger, S, Sonnemann, U, Buchert, R, Werner, JA et al. FDG PET detection of unknown primary tumors. J Nucl Med 2000;41:816–22Google ScholarPubMed
27Jungehülsing, M, Scheidhauer, K, Damm, M, Pietrzyk, U, Eckel, H, Schicha, H et al. 2[F]-fluoro-2-deoxy-D-glucose positron emission tomography is a sensitive tool for the detection of occult primary cancer (carcinoma of unknown primary syndrome) with head and neck lymph node manifestation. Otolaryngol Head Neck Surg 2000;123:294–301CrossRefGoogle ScholarPubMed
28Johansen, J, Eigtved, A, Buchwald, C, Theilgaard, SA, Hansen, HS. Implication of 18F-fluoro-2-deoxy-D-glucose positron emission tomography on management of carcinoma of unknown primary in the head and neck: a Danish cohort study. Laryngoscope 2002;112:2009–14CrossRefGoogle ScholarPubMed
29Fogarty, GB, Peters, LJ, Stewart, J, Scott, C, Rischin, D, Hicks, RJ. The usefulness of fluorine 18-labelled deoxyglucose positron emission tomography in the investigation of patients with cervical lymphadenopathy from an unknown primary tumor. Head Neck 2003;25:138–45CrossRefGoogle ScholarPubMed
30Regelink, G, Brouwer, J, de Bree, R, Pruim, J, van der Laan, BF, Vaalburg, W et al. Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities. Eur J Nucl Med Mol Imaging 2002;29:1024–30CrossRefGoogle ScholarPubMed
31Rusthoven, KE, Koshy, M, Paulino, AC. The role of fluorodeoxyglucose positron emission tomography in cervical lymph node metastases from an unknown primary tumor. Cancer 2004;101:2641–9CrossRefGoogle ScholarPubMed
32Beyer, T, Townsend, DW, Brun, T, Kinahan, PE, Charron, M, Roddy, R et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41:1369–79Google ScholarPubMed
33Mendenhall, WM, Mancuso, AA, Parsons, JT, Stringer, SP, Cassisi, NJ. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 1998;20:739–443.0.CO;2-0>CrossRefGoogle ScholarPubMed