Dual Modality of &lt;sup&gt;18&lt;/sup&gt;F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Patients with Cervical Carcinoma of Unknown Primary

Freudenberg, Lutz S.; Fischer, Markus; Antoch, Gerald; Jentzen, Walter; Gutzeit, Andreas; Rosenbaum, S.; Bockisch, Andreas; Egelhof, Thomas

doi:10.1159/000084632

Cited by 78 publications

(52 citation statements)

References 57 publications

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“…It is well known that the identification of the UPC localization is a fundamental prerequisite for optimization of treatment planning, and failure to detect the UPC is characterized by higher mortality (22). Whole-body PET/CT using 18 F-FDG has been successfully used for the detection of UPC of the most common malignancies (detection rate, 24%240%) (23)(24)(25)(26). However, to our knowledge only 1 systematic study has evaluated the role of 68 Ga-DOTANOC PET/CT for the assessment of UPC in NET patients (27).…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

Ambrosini¹,

Campana²,

Bodei³

et al. 2010

J Nucl Med

219

124

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Several authors reported the superiority of 68 Ga-DOTANOC PET/ CT to conventional imaging (CI) for the assessment of neuroendocrine tumors (NET). However, the detection of a higher number of lesions is not necessarily followed by a modification of disease stage or therapeutic approach. The aim of this study was to assess the impact of 68 Ga-DOTANOC PET/CT on the clinical management of NET patients. Methods: The study included 90 patients with pathologic confirmation of NET, CT performed within a month of 68 Ga-DOTANOC PET/CT, and a follow-up period of at least 1 y. PET/CT results were compared with CI results. As a standard of reference to finally evaluate PET results, clinical and imaging follow-up data were used. To assess the clinical impact of PET findings, all referring physicians were contacted after PET and asked about how patients were managed. Stage or therapy modifications were independently recorded, and the overall impact was evaluated patient by patient if PET results either affected therapy or caused a change in disease stage. Results: Considering PET/CT and CI concordant cases (47/90 [52.2%]), PET findings affected the therapeutic management in 17 of 47 (36.2%) patients. Although PET did not result in modification of disease stage, 68 Ga-DOTANOC detected a higher lesion number in most patients. PET/CT and CI findings were discordant in 42 of 90 (46.7%) patients: PET resulted in a modification of stage in 12 patients (28.6%) and affected the treatment plan in 32 patients (76.2%). PET and CT were both equivocal in 1 patient (1/90). Considering all cases, 68 Ga-DOTANOC PET/CT affected either stage or therapy in 50 of 90 (55.5%) patients. The most frequent impact on management (27 patients) was the initiation or continuance of peptide receptor radionuclide therapy, followed by the initiation or continuance of somatostatin analog medical treatment (7 patients) and referral to surgery (6 patients). PET prevented unnecessary surgery in 6 patients and excluded from treatment with somatostatin analogs 2 patients with NET lesions that did not express somatostatin receptors. Less frequent impacts on management included the initiation of radiotherapy (1 patient), further diagnostic investigation (1 patient), and liver transplantation (1 patient). Conclusion: 68 Ga-DOTANOC PET/CT either affected stage or caused a therapy modification in more than half the patients, thus confirming the clinical role of PET in the management of NET.

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Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

Ambrosini¹,

Campana²,

Bodei³

et al. 2010

J Nucl Med

219

124

View full text Add to dashboard Cite

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“…In the search for a primary tumor in the head and neck, a CT scan may be either complemented or supplanted by MRI with gadolinium contrast, which exhibits superior soft tissue resolution, particularly for the evaluation of the nasopharynx or oropharynx. The potential of CT, MRI or both to detect a primary tumor ranges from 9.3 to 23% (3,18,19), rising to 60% when suspicious radiological findings direct subsequent endoscopic biopsies (20). Over the last 2 decades, positron emission tomography (PET) has also been used in patients with CUP.…”

Section: Diagnostic Work-upmentioning

confidence: 99%

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Zhuang

et al. 2014

Molecular and Clinical Oncology

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Abstract. Cancer of unknown primary site (CUP) is an intriguing clinical phenomenon found in ~3-9% of all head and neck cancers. It has not yet been determined whether CUP forms a distinct biological entity with specific genetic and phenotypic characteristics, or whether it is the clinical presentation of metastasis in patients with an undetected primary tumor and no visible clinical signs. The treatment of patients with cervical lymph node metastases from CUP remains controversial, due to the lack of randomized clinical trials comparing different treatment options. Consequently, treatment is currently based on non-randomized data and institutional policy. In the present review, the range and limitations of diagnostic procedures are summarized and an optimal diagnostic work-up is recommended. The initial preferred diagnostic procedures include fine-needle aspiration biopsy (FNAB) and imaging. Although neck dissection followed by postoperative radiotherapy is the the most generally accepted approach, other curative options may be used in certain patients, such as neck dissection alone, nodal excision followed by postoperative radiotherapy, or radiotherapy alone. There remains controversy regarding target radiation volumes, ranging from ipsilateral neck irradiation to prophylactic irradiation of all the potential mucosal sites and both sides of the neck. When no primary lesion is identified with imaging and endoscopy in patients without history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus and/or Epstein-Barr virus is required.

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“…This limitation can be overcome by collecting functional and morphological data in one examination using PET/CT tomographs [16]. Preliminary studies report promising results when malignant diseases of the head-and-neck area are assessed with combined PET/CT [17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Dual-modality FDG-PET/CT in follow-up of patients with recurrent iodine-negative differentiated thyroid cancer

et al. 2007

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The usefulness of combined 2-[18F] fluoro-2-deoxy-D: -glucose positron emission tomography and computed tomography (FDG-PET/CT) in locating suspected recurrence in patients with iodine-negative differentiated thyroid cancer (DTC) was evaluated. Thirty-six patients with DTC and suspected iodine-negative recurrence underwent restaging with FDG-PET/CT. The images of CT, FDG-PET, both modalities viewed side by side (CT+PET), and FDG-PET/CT were evaluated by two physicians separately. Imaging results were correlated with either histology (n = 20) and/or clinical follow-up of at least 36 months. Recurrent disease was diagnosed in 22/36 patients. FDG-PET alone, CT alone, CT+PET, and FDG-PET/CT showed a sensitivity of 82%, 73%, 91%, and 96%, respectively. Specificities were 79%, 71%, 79%, and 100%, respectively. FDG-PET/CT significantly improved specificity compared with CT+PET and resulted in a further treatment modification in 5/36 patients (14%). CT alone was especially sensitive for lung metastases, FDG-PET alone for the remainder of the body. Accurate fusion of functional and morphologic data by FDG-PET/CT improves the staging accuracy of patients with suspected recurrence of iodine-negative DTC. This has an impact on patient management in a substantial number of patients.

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Dual Modality of <sup>18</sup>F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Patients with Cervical Carcinoma of Unknown Primary

Cited by 78 publications

References 57 publications

⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Dual-modality FDG-PET/CT in follow-up of patients with recurrent iodine-negative differentiated thyroid cancer

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Dual Modality of <sup>18</sup>F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Patients with Cervical Carcinoma of Unknown Primary

Cited by 78 publications

References 57 publications

68Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

68Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Dual-modality FDG-PET/CT in follow-up of patients with recurrent iodine-negative differentiated thyroid cancer

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⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors