Localised disease in cancer of unknown primary (CUP): The value of positron emission tomography (PET) for individual therapeutic management

Rades, Dirk; Kühnel, G; Wildfang, I.; Börner, A.-R.; Schmoll, Hans‐Joachim; Knapp, Wolfram H.

doi:10.1023/a:1013107732572

Cited by 86 publications

(61 citation statements)

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“…Nevertheless, there remains a core of patients for whom the primary is uncertain. Rades et al (2001) reported that PET allowed detection of the primary site in 43% (18 out of 42 patients) of the study population that included only localised CUP based on conventional staging procedures. Dissemination was detected by PET in 38%, and in 69%, the PET result influenced the selection of the definitive treatment.…”

Section: Discussionmentioning

confidence: 99%

Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary

et al. 2008

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Carcinomas of unknown primary (CUP) represent between 3 and 10% of malignancies. Treatment with nonspecific chemotherapy is commonly unhelpful and the median survival is between 3 and 6 months. Gene expression microarray (GEM) analysis has demonstrated that molecular signatures can aid in tumour classification and propose foster primaries. In this study, we demonstrate the clinical utility of a diagnostic gene expression profiling tool and discuss its potential implications for patient management strategies. Paraffin tumour samples from 21 cases of 'true' CUP patients in whom standard investigation had failed to determine a primary site of malignancy were investigated using diagnostic gene profiling. The results were reviewed in the context of histology and clinical history. Classification of tumour origin using the GEM method confirmed the clinicians' suspicion in 16 out of 21 cases. There was a clinical/ GEM inconsistency in 4 out of 21 patients and a pathological/GEM inconsistency in 1 patient. The improved diagnoses by the GEM method would have influenced the management in 12 out of 21 cases. Genomic profiling and cancer classification tools represent a promising analytical approach to assist with the management of CUP patients. We propose that GEM diagnosis be considered when the primary clinical algorithm has failed to provide a diagnosis.

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Section: Discussionmentioning

confidence: 99%

Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary

et al. 2008

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“…7,[9][10][11][12][13][14][15][16][17][18][19][20] These figures, however, were reported in series that included patients with CUP and extracervical metastases as well as varying cancer types, for example, SCC, adenocarcinoma, melanoma, large cell carcinoma, plasmocytoma, etc., and the diagnostic performance of FDG-PET was not determined separately for cervical versus extracervical CUP presentations and as a function of the histological subtype. Further, in several of these studies, the PET methodology was either not standardized or inadequate and most of these studies were conducted using FDG-PET and not FDG-PET/CT, which might have resulted in a higher rate of false-positive findings and sensitivity.…”

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confidence: 99%

Lymph Node Metastasis of Squamous Cell Carcinoma from an Unknown Primary in the Upper and Middle Neck: Impact of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Deron

Bonte

Vermeersch

et al. 2011

Cancer Biotherapy and Radiopharmaceuticals

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Purpose: The purpose of this study was to assess the potential of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging for detection of the primary tumor and its impact on treatment planning in patients presenting with cancer of unknown primary and squamous cell carcinoma (SCC)-positive cervical lymph nodes of the upper and middle neck. Methods: The study population consisted of 18 consecutive patients with biopsy-proven SCC involving lymph nodes of the upper and middle neck region and negative conventional diagnostic procedures with regard to the location of the primary. All patients underwent FDG-PET/CT according to a standard procedure in search for the primary, unidentified tumor. Results: In none of the patients FDG-PET/CT was able to indicate a primary tumor localization. Although FDG-PET/CT did identify all sites of known lymph node involvement, neither additional sites of lymph node involvement nor sites of distant metastases were identified. Accordingly, FDG-PET/CT did not impact patient treatment planning. Conclusions: In this series, including patients suffering from lymph node metastases by an SCC of unknown primary in the upper and middle neck, FDG-PET/CT was unable to identify a primary tumor. In addition, FDG-PET/CT did not modify the treatment planning in any of the patients studied.

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“…PET (positron emission tomography) with the use of 18-fluorodeoxyglucose in combination with the CT examination is considered by many authors as the method of high efficacy, both in the determination of the primary lesion (40-60%), and staging of the neoplastic process (26,27,28). Greven et al pointed to the limited specificity of 18-FDG PET: the primary lesion was diagnosed in 1 of 13 analysed cases with a high percentage of false positive results (29).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Imaging Efficacy In Metastases From Unknown Primary Site – Own Material

Bara¹,

Pluta²,

Jeziorski³

2015

Polish Journal of Surgery

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Cancer of Unknown Primary Origin (CUPO) is defined by the presence of metastatic lesions, diagnosed by means of cytological or pathological evaluation, for which no primary site can be detected during a thorough examination. The clinical investigation, directed at locating the site of the neoplastic lesion, is determined by the results of laboratory tests, imaging procedures, and pathological examinations. It is also essential to conduct a complete medical history and thorough physical examination. The detection of the primary site allowed to introduce specific therapy, which can offer clinical benefits, considering a favorable prognosis.was to assess the range of diagnostic procedures performed in patients with CUPO and efficacy in identifying the primary lesion.Retrospective analysis comprised a group of 29 patients with CUPO, operated between January, 2002 and December, 2011, at the Department of Surgical Oncology, Medical University in Łódź. The study group comprised 16 male and 13 female patients; median age at presentation was 58.3 years (ranging between 30-79 years).Detailed diagnostic management depending on the location of metastatic lesions and their histological type was performed in 20 of the 29 study patients (69%). Considering the remaining 9 (31%) patients detailed diagnostics was not performed, due to the patients' poor general condition. In 55% (11/20) of patients subject to detailed diagnostics, the primary neoplastic lesion was determined.Considering the study group, most patients with cancer of unknown primary origin were characterized by a favorable prognosis, which justified thorough diagnostics, in order to establish the primary neoplastic lesion. The introduction of diagnostic examinations enabled to identify the primary site of the tumor in more than 50% of patients. With the development of imaging methods one can expect improvement of unsatisfactory results, considering the detection of primary neoplastic foci.

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Localised disease in cancer of unknown primary (CUP): The value of positron emission tomography (PET) for individual therapeutic management

Abstract: In CUP patients, PET has a certain impact on detection of the primary as well as of the disseminated disease. and may also have a certain impact on therapeutic management.

Cited by 86 publications

References 18 publications

Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary

Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary

Lymph Node Metastasis of Squamous Cell Carcinoma from an Unknown Primary in the Upper and Middle Neck: Impact of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Diagnostic Imaging Efficacy In Metastases From Unknown Primary Site – Own Material

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Localised disease in cancer of unknown primary (CUP): The value of positron emission tomography (PET) for individual therapeutic management

Abstract: In CUP patients, PET has a certain impact on detection of the primary as well as of the disseminated disease. and may also have a certain impact on therapeutic management.

Cited by 86 publications

References 18 publications

Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary

Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary

Lymph Node Metastasis of Squamous Cell Carcinoma from an Unknown Primary in the Upper and Middle Neck: Impact of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Diagnostic Imaging Efficacy In Metastases From Unknown Primary Site – Own Material

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Lymph Node Metastasis of Squamous Cell Carcinoma from an Unknown Primary in the Upper and Middle Neck: Impact of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography