Clinical utility of PET/CT in the evaluation of head and neck squamous cell carcinoma with an unknown primary: A prospective clinical trial

• Published in: Head & neck Vol. 33; no. 7; pp. 935 - 940
• Main Authors: Rudmik, Luke, Lau, Harold Y., Matthews, T. Wayne, Bosch, J. Douglas, Kloiber, Reinhard, Molnar, Christine P., Dort, Joseph C.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.07.2011; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - secondary; clinical utility; Female; head and neck imaging; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - secondary; head and neck squamous cell carcinoma; Humans; Male; Medical sciences; Middle Aged; Neoplasms, Unknown Primary - diagnosis; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; PET/CT; Positron-Emission Tomography; Predictive Value of Tests; Preoperative Period; Prospective Studies; Squamous Cell Carcinoma of Head and Neck; Tomography, X-Ray Computed; Tumors; unknown primary; Radionuclide study; head and neck imaging; Evaluation; Radiodiagnosis; Stomatology; unknown primary; ENT; Malignant tumor; clinical utility; PET/CT; Head and neck; Medical imagery; ENT disease; Head and neck cancer; Head and neck squamous cell carcinoma; Clinical trial; Computerized axial tomography; Positron emission tomography; Cancer; Emission tomography
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.21566

Background Metastatic head and neck squamous cell carcinoma with an unknown primary is an uncommon but important problem. PET/CT, as an adjunct to diagnosis, is potentially useful but has never been studied in a prospective, single‐blinded clinical trial. Methods In all, 20 subjects with cervical metastases from an unknown head and neck primary were enrolled in a prospective clinical trial. A standard protocol was used in both clinic and operating room (OR). Study surgeons were blinded to the PET/CT result upon completion of the standard work‐up. Results PET/CT increased the detection of a primary site from 25% to 55% (5 vs 11 subjects). This difference was statistically and clinically significant (p = .03, McNemar's test). There was 1 false negative PET/CT scan. Conclusions An unknown primary should be diagnosed only after a complete head and neck examination, flexible endoscopy, and CT or MRI. PET/CT performed prior to panendoscopy will increase the diagnostic yield in the unknown head and neck primary population, leading to more targeted, and less morbid, treatment. © 2010 Wiley Periodicals, Inc. Head Neck, 2011