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

Johansen, Jørgen; Eigtved, Annika; Buchwald, Christian von; Theilgaard, Sune A.; Hansen, Hanne Sand

doi:10.1097/00005537-200211000-00018

Cited by 103 publications

(54 citation statements)

References 18 publications

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“…This explains the reported differences in the accuracy for FDG-PET applied in the search for the primary tumor site. In our study, 11 primary tumors corresponding to a success rate of 52% were correctly identifi ed similar to previous reports [4,[11][12][13][14][29][30][31][32][33][34] .…”

Section: Discussionsupporting

confidence: 89%

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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

Freudenberg¹,

Fischer²,

Antoch

et al. 2005

Med Princ Pract

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Objective: To evaluate an optimized F-18-flurodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) acquisition protocol for head and neck cancer and assess the usefulness of combined FDG-PET/CT in locating unknown primary tumors in patients with biopsy-proven cervical lymph node metastases. Subjects and Methods: Twenty-one patients with cervical lymph node metastases of unknown primary tumors underwent staging with FDG-PET/CT. The images of FDG-PET alone, CT alone, FDG-PET/CT read side by side and fused and FDG-PET/CT were evaluated separately by 2 physicians. Imaging results were correlated with either histology (n = 14) or clinical follow-up (n = 7). Results: On the fused FDG-PET/CT images, primary tumors were identified in 12 patients (57%); with FDG-PET alone and FDG-PET and CT read side by side 11 (52%) primary tumors were found while CT alone identified 5 (23%) primary tumors. Conclusion: Our data indicate that fused FDG-PET and CT images increased the sensitivity of detecting carcinoma of unknown primary (CUP) tumors compared to CT alone, but not to FDG-PET alone or FDG-PET and CT read side by side. Hence accurate fusion of functional and morphologic data by FDG-PET/CT is a promising imaging modality in the clinical workup of patients with cervical CUP tumors.

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Section: Discussionsupporting

confidence: 89%

“…In contrast FDG-PET is superior in locating CUP with varying detection rates from 23% up to 90% depending on the preselected patient population [4,[11][12][13][14][29][30][31][32][33][34] . As until now, no consensus has been established on how routine clinical workup should be done in patients with CUP.…”

Section: Discussionmentioning

confidence: 99%

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

Freudenberg¹,

Fischer²,

Antoch

et al. 2005

Med Princ Pract

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“…FDG-PET has proved to be a complementary study for patients with unknown primary tumor of the head and neck when conventional evaluation fails (Fig 2). [11][12][13][14][15][16][17][18] A review of 16 studies published between 1994 and 2003 evaluating the utility of FDG-PET in identifying unknown primary carcinomas af- PET/CT showed a 1.0 ϫ 1.2 cm hypermetabolic (gold arrow) and enhancing (red arrow) lesion at the right base of the tongue, large nodes in the right levels II/III, an 8-mm node at level IV, and no left-sided nodes or distant metastases. Direct laryngoscopy with biopsy and cervical esophagoscopy showed no lesions, but palpation showed a 1-cm firm right base of tongue lesion not crossing the midline, which was pathologically proved to be SCC.…”

Section: Detection Of Unknown Primary Tumormentioning

confidence: 99%

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Subramaniam

Truong

Peller

et al. 2009

AJNR Am J Neuroradiol

107

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SUMMARY:The hybrid technique of PET/CT has significantly impacted the imaging and management of HNSCC since its introduction in 2001 and has become the technique of choice for imaging of this cancer. Diagnostic FDG-PET/CT is useful for identification of an unknown primary tumor, delineation of extent of primary tumor, detection of regional lymph node involvement even in a normal-sized node, detection of distant metastases and occasional synchronous primary tumor, assessment of therapy response, and long-term surveillance for recurrence and metastases. The role of PET/CT is evolving in radiation therapy planning. Combined diagnostic PET/CT provides the best anatomic and metabolic in vivo information for the comprehensive management of HNSCC.ABBREVIATIONS: CR ϭ complete response; DCT ϭ contrast enhanced diagnostic CT;18 F ϭ fluorine-18; FDG ϭ fluorodeoxyglucose; FDG-PET ϭ fluorodeoxyglucose-positron-emission tomography; FNA ϭ fine-needle aspiration; GTV ϭ gross tumor volume; HNSCC ϭ head and neck squamous cell carcinomas; IMRT ϭ intensity modulated radiation therapy; M ϭ metastasis; N ϭ node; PET ϭ positron-emission tomography; PTV ϭ planning target volume; RD ϭ residual disease; SCC ϭ squamous cell carcinoma; SUV ϭ standard uptake value; SUV max ϭ maximum SUV; T ϭ tumor M ore than 40,000 people are diagnosed with head and neck cancer each year in the United States.1 The overall annual mortality rate for this cancer in the United States is 23%, and the 5-year survival rate is 56%.1-3 More than 80% of early-stage tumors are cured, but nearly one-half of patients have evidence of advanced local disease or lymph node metastases at the time of diagnosis. Surgery and radiation therapy, either alone or in combination with chemotherapy, are used for definitive locoregional treatment of head and neck cancers. For patients with advancedstage and high-risk features, postoperative chemoradiation improves locoregional control and overall survival. 4,5 Cross-sectional imaging with CT and MR imaging is commonly used for tumor staging and may allow detection of subcentimeter lesions. Locoregional lymph node metastases have a major impact on survival. Patients with lymph-node involvement have a worse prognosis (approximately 30%) than patients without lymph node involvement (Ͼ50% 5-year survival). 6,7 PET using the radiotracer 18 F FDG is widely used to evaluate patients with HNSCC. The hybrid technique, PET/CT, provides anatomic and functional information and can be performed as PET and DCT with intravenous contrast-enhancement (PET/ DCT) or PET and noncontrast CT (PET/CT) for attenuation correction and anatomic localization. PET/CT is useful for identification of an unknown primary tumor, delineation of the extent of regional lymph node involvement, detection of distant metastases and occasional synchronous primary tumor, radiation-therapy planning, assessing therapy response, and long-term surveillance for recurrence and metastases.PET/CT Protocols PET/CT imaging was developed to improve PET imaging by expediting attenuation c...

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“…larynx, and upper esophagus), anatomic imaging with CT and/or MRI, and blind tongue base biopsy. Numerous studies have addressed the ability of PET to identify primary locations after traditional work-up [29][30][31]. A meta-analysis by Rusthoven and colleagues [32] showed that PET was able to recognize a primary tumor after negative conventional work-up in one quarter of patients with an overall sensitivity and specificity of 88% and 75%, respectively.…”

Section: Unknown Primary Tumorsmentioning

confidence: 99%

Indications for PET/CT in the Head and Neck

Agarwal

Branstetter

Johnson

2008

Otolaryngologic Clinics of North America

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Head and neck cancer accounts for approximately 3% to 5% of all new cancer diagnoses in the United States with 40,000 new cases diagnosed each year [1]. These figures encompass cancers arising from the lip, oral cavity, nasal cavity, paranasal sinuses, pharynx, and larynx, of which the vast majority (90% to 95%) are squamous cell carcinomas arising from mucosal linings of the upper aerodigestive tract. Other, rare cancers that may involve the head and neck include salivary tumors, thyroid cancers, lymphoma, and melanoma.Early diagnosis and accurate staging are essential for treatment planning and can strongly influence prognosis. Likewise, early identification of tumor recurrence can often be treated with additional surgery or re-irradiation. A combination of history, physical exam, endoscopy, and tissue sampling has historically been the mainstay of diagnosis and staging. The use of crosssectional imaging (CT and MRI) has greatly improved staging and monitoring for disease recurrence. Small metastases and/or early recurrent disease, however, can still be missed [2].Functional imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used to fill these gaps and improve characterization of both primary tumors and metastatic disease. PET has been shown to be effective in the diagnosis of many different types of cancer, including head and neck squamous cell carcinoma (HNSCC) [3]; however, the poor spatial resolution of PET and the lack of anatomic landmarks can make exact localization of disease difficult. In addition, normal

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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

Abstract: With our present strategy of wide-field irradiation in patients with neck node metastases from a carcinoma of unknown primary, whole-body 18F-FDG PET had treatment-related implications in 24% (10 of 42) of the patients.

Cited by 103 publications

References 18 publications

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

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

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Indications for PET/CT in the Head and Neck

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