TY - JOUR
T1 - The role of fluorodeoxyglucose positron emission tomography in cervical lymph node metastases from an unknown primary tumor
AU - Rusthoven, Kyle E.
AU - Koshy, Mary
AU - Paulino, Arnold C.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2004/12/1
Y1 - 2004/12/1
N2 - BACKGROUND. The authors performed a comprehensive review of the efficacy of fluorodeoxyglucose positron emission tomography (FDG-PET) in the detection of primary tumors in patients with cervical metastases from unknown primary tumors. METHODS. Sixteen studies (involving a total of 302 patients) published between 1994 and 2003 were reviewed. These studies evaluated the role of FDG-PET in the detection of unknown primary tumors after conventional workup. In all studies, conventional workup included either panendoscopy or computed tomographic/ magnetic resonance imaging, and in 10 of 16 studies, both of these diagnostic techniques were performed before diagnosis. RESULTS. The overall sensitivity, specificity, and accuracy rates of FDG-PET in detecting unknown primary tumors were 88.3%, 74.9%, and 78.8%, respectively. Furthermore, FDG-PET detected 24.5% of tumors that were not apparent after conventional workup. FDG-PET imaging also led to the detection of previously unrecognized metastases in 27.1% of patients (regional, 15.9%; distant, 11.2%). FDG-PET had notably low specificity and a high false-positive rate (39.3%) in the tonsils. In contrast, the false-positive rates for FDG-PET of the base of tongue and hypopharynx were only 21.4% and 8.3%, respectively. FDG-PET exhibited decreased sensitivity to tumors in the base of tongue (81.5%). The sensitivity of this technique at other sites was 90.5%. CONCLUSIONS. FDG-PET detected primary tumors that went undetected by other modalities in approximately 25% of cases and was sensitive in the detection of previously unrecognized regional or distant metastases in 27% of cases. FDG-PET had low specificity for tonsillar tumors and low sensitivity for base-of-tongue malignancies.
AB - BACKGROUND. The authors performed a comprehensive review of the efficacy of fluorodeoxyglucose positron emission tomography (FDG-PET) in the detection of primary tumors in patients with cervical metastases from unknown primary tumors. METHODS. Sixteen studies (involving a total of 302 patients) published between 1994 and 2003 were reviewed. These studies evaluated the role of FDG-PET in the detection of unknown primary tumors after conventional workup. In all studies, conventional workup included either panendoscopy or computed tomographic/ magnetic resonance imaging, and in 10 of 16 studies, both of these diagnostic techniques were performed before diagnosis. RESULTS. The overall sensitivity, specificity, and accuracy rates of FDG-PET in detecting unknown primary tumors were 88.3%, 74.9%, and 78.8%, respectively. Furthermore, FDG-PET detected 24.5% of tumors that were not apparent after conventional workup. FDG-PET imaging also led to the detection of previously unrecognized metastases in 27.1% of patients (regional, 15.9%; distant, 11.2%). FDG-PET had notably low specificity and a high false-positive rate (39.3%) in the tonsils. In contrast, the false-positive rates for FDG-PET of the base of tongue and hypopharynx were only 21.4% and 8.3%, respectively. FDG-PET exhibited decreased sensitivity to tumors in the base of tongue (81.5%). The sensitivity of this technique at other sites was 90.5%. CONCLUSIONS. FDG-PET detected primary tumors that went undetected by other modalities in approximately 25% of cases and was sensitive in the detection of previously unrecognized regional or distant metastases in 27% of cases. FDG-PET had low specificity for tonsillar tumors and low sensitivity for base-of-tongue malignancies.
KW - Cervical lymph node metastasis
KW - Fluorodeoxyglucose positron emission tomography
KW - Head and neck carcinoma
KW - Unknown primary tumor
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U2 - 10.1002/cncr.20687
DO - 10.1002/cncr.20687
M3 - Review article
C2 - 15517576
AN - SCOPUS:8844254613
SN - 0008-543X
VL - 101
SP - 2641
EP - 2649
JO - Cancer
JF - Cancer
IS - 11
ER -