Diagnostic strategies in cervical carcinoma of an unknown primary (CUP)

Haas, I.; Hoffmann, Thomas; Engers, Rainer; Ganzer, U.

doi:10.1007/s00405-002-0470-1

Cited by 140 publications

(151 citation statements)

References 37 publications

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“…As detection of the primary has a great impact on both the curative loco-regional treatment and the prognosis of these patients, maximum effort should be made to localise the primary, even the search for a primary tumor is often costly and time-consuming. In the study by Haas et al, the 3-year survival rate in patients with identified head and neck primary tumours was 100% after treatment, compared to 58% in patients with unknown primary tumours (7). But as is known from the literature, there are still patients whose primary tumour will never be found (8).…”

Section: Discussionmentioning

confidence: 99%

Impact of FDG-PET/CT for the Detection of Unknown Primary Tumours in Patients with Cervical Lymph Node Metastases

Karapolat

Kumanlıoğlu²

2012

MIRT

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Objective: Because the detection of the primary tumour is of importance to optimize the patient’s management and allows a targeted therapy, the performance of hybrid positron emission tomography–computed tomography (PET/CT) using fluorodeoxyglucose (FDG) in the detection of primary tumors and unrecognized metastases with cervical lymph node metastases were evaluated in a retrospective study. Material and Methods: Twenty patients with cervical lymph node metastases of unknown primary tumors underwent staging with FDG-PET/CT. All underwent head and neck examinations, computed tomography (CT), and/or magnetic resonance imaging (MRI), panendoscopies, and biopsies of head and neck mucosal sites. The diagnostic accuracy of FDG-PET/CT in detecting primary tumors was compared with that of histopathology and clinical follow-up. The ability of FDG-PET/CT to detect distant metastases was also tested. Results: PET/CT was positive with an increased FDG uptake suggesting the potential primary site in 45% of patients (9/20). PET/CT findings were true positive in 7, true negative in 10, false positive in 2, and false negative in 1 patients, resulting in a sensitivity of 87%, a specificity of 83%, an accuracy of 85%, a positive predictive value of 77% and a negative predictive value of 90%. Also, PET/CT showed distant metastases in seven patients. Conclusion: FDG-PET/CT can be successfully used for the identification of the primary site and distant metastases in patients with cervical lymph node metastases from an unknown primary cancer. Conflict of interest:None declared.

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Section: Discussionmentioning

confidence: 99%

Impact of FDG-PET/CT for the Detection of Unknown Primary Tumours in Patients with Cervical Lymph Node Metastases

Karapolat

Kumanlıoğlu²

2012

MIRT

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“…The most frequently encountered primary symptom is a cervical mass due to enlarged lymph nodes (94%) [15], mostly located in level 2 (30–50%), followed by level 1 and 3 (10–20%) and 4 and 5 (5–10%) [2, 15]. Bilateral involvement of the neck is reported in less than 10% of the cases [6, 8, 15, 18, 19, 29, 30]. When node metastases are found in levels 1-3, the primary site is suspected to be in the head and neck region.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges

et al. 2017

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Background and PurposeThis review aims to provide a comprehensive overview of the literature and elucidate open questions for future clinical trials concerning diagnostics and treatment modalities for cervical cancer of unknown primary (CUP).MethodsA literature search for head and neck CUP was performed with focus on diagnostics and therapies as well as molecular markers.ResultsHigh level evidence on CUP is limited. However, it seems that a consensus exists regarding the optimal diagnostic procedures. The correct implementation of biomarkers for patient stratification and treatment remains unclear. An even greater dispute dominates about the ideal treatment with publications ranging from sole surgery to surgery with postoperative bilateral radiotherapy with inclusion of the mucosa and concomitant chemotherapy.ConclusionsCervical CUP represents a very heterogeneous malignant disease. On this account many aspects concerning treatment optimization remain unclear, despite a considerable number of publications in the past. Future research in form of prospective randomized trials is needed in order to better define patient stratification criteria and enable tailored treatment.

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“…CUP metastatic to the cervical lymph nodes accounts for ∼3–5% of all head and neck cancers (3). Squamous cell carcinoma (SCC) is the most common histology, representing 65% of cases, followed by undifferentiated carcinoma (22%) and adenocarcinoma (13%) (4). However, in the case of supraclavicular node metastases, 50–76% patients have adenocarcinoma (5).…”

Section: Discussionmentioning

confidence: 99%

“…Immunohistochemical findings are crucial in forming a differential diagnosis. Communication between the pathologist and clinician is extremely important for defining the tumor origin (4). There are a number of relatively specific tumor markers that may aid in the identification of the site of the cancer.…”

Section: Discussionmentioning

confidence: 99%

Fluid biopsy for circulating tumor cells in an occult ovarian cancer patient exhibiting bilateral supraclavicular lymph node metastases: A case report

Chen

et al. 2013

Oncology Letters

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Metastases to the supraclavicular region usually originate from the head and neck or from infraclavicular tumors. Ovarian primaries of supraclavicular metastases are extremely rare. The present study reports the case of a 60-year-old patient with a bilateral supraclavicular mass that was diagnosed as a poorly-differentiated squamous cell carcinoma of unknown primary, following a fine-needle aspiration biopsy (FNAB) and comprehensive clinical investigation. The analysis of a peripheral blood sample using the CellSearch system revealed the presence of circulating tumor cells (CTCs) that were positive for epithelial cell adhesion molecule (EpCAM) and cytokeratin (CK) expression. Since EpCAM is usually expressed in adenocarcinoma, an excisional biopsy of the right supraclavicular lymph node was performed. The patient was diagnosed with occult ovarian low-grade serous carcinoma by immunohistochemistry. To the best of our knowledge, this is the first report to demonstrate that CTCs may be detected in the peripheral blood of a patient with cancer of unknown primary (CUP) by using the CellSearch system. A literature review was performed to analyze the diagnostic procedures of CUP metastatic to the cervical lymph nodes and the clinical features of CTCs.

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Diagnostic strategies in cervical carcinoma of an unknown primary (CUP)

Cited by 140 publications

References 37 publications

Impact of FDG-PET/CT for the Detection of Unknown Primary Tumours in Patients with Cervical Lymph Node Metastases

Impact of FDG-PET/CT for the Detection of Unknown Primary Tumours in Patients with Cervical Lymph Node Metastases

Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges

Fluid biopsy for circulating tumor cells in an occult ovarian cancer patient exhibiting bilateral supraclavicular lymph node metastases: A case report

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