Complete Pathological response significantly improves overall and disease free survival. It is also the predictor of long term survival.

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.

Low-volume centers are an acceptable alternate to high-volume centers for performing pancreaticoduodenal resection in carefully selected patients. Efforts should be directed at developing specialized hepatobiliary centers in developing countries.

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Incidence of interval cancers is an important outcome in assessing efficacy of screening. Our primary objective was to compare the incidence of interval cancers detected with two‐dimensional digital mammography (DM) versus digital breast tomosynthesis (DBT) in a large community health system. Our secondary objectives were to compare the patient and tumor characteristics of interval cancers, cancer detection rate, and recall rate. Interval cancers before and after implementation of DBT (2012‐2014 DM group; 2016‐2018 DBT group) were reviewed. Patient factors (age, race, breast density, personal history of breast cancer, family history of breast cancer, known BRCA‐1 or BRCA‐2 genetic mutation, baseline mammogram, and presentation) and tumor characteristics (in situ versus invasive, grade, size, hormone receptor status, and nodal status) were compared with the chi‐squared test or the MidP exact test. Rates (detection and recall) were compared using a z‐score. The rates of interval cancers with DM (0.30 per 1000 [35/117 099]) and DBT (0.33 per 1000 [40/119 746]) were similar (P = .3). Proportion of node‐positive interval cancers was lower in the DBT group (22.9% [8/35] vs 48% [15/31], p.01). Otherwise, the patient and tumor characteristics were similar. The cancer detection rate increased (5.9 per 1000 [709/119 746] vs 3.5 per 1000 [411/117 099], P = .0001), and the recall rate decreased with DBT (8.6% [10 347/119 746] versus 10.7% [12 508/117 099], (P < .0001). Although the cancer detection rate was higher with DBT, the rate of interval breast cancers was similar in both groups. Node‐positive invasive interval cancers were decreased with DBT.