Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study

• Published in: Head & neck Vol. 30; no. 4; pp. 471 - 478
• Main Authors: Johansen, Jørgen, Buus, Simon, Loft, Annika, Keiding, Susanne, Overgaard, Marie, Hansen, Hanne Sand, Grau, Cai, Bundgaard, Troels, Kirkegaard, Jørgen, Overgaard, Jens
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2008; John Wiley & Sons
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy; Bone; Carcinoma; Carcinoma - diagnostic imaging; Carcinoma - therapy; cervical lymph node metastasis; Endoscopy; Female; flourodeoxyglucose; Fluorodeoxyglucose F18; Follow-Up Studies; Head; head and neck cancer; Hematologic and hematopoietic diseases; Humans; Hypopharynx; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lung; Lymph nodes; Lymphatic Metastasis; Magnetic resonance imaging; Male; Medical sciences; Metastases; Middle Aged; Mucosa; Nasopharynx; Neck; Neck Dissection; Neoplasms - diagnostic imaging; Neoplasms - therapy; Neoplasms, Unknown Primary; Oropharynx; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Positron-Emission Tomography; Practice Guidelines as Topic; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Radiotherapy, Adjuvant; Rectum; Sensitivity and Specificity; Tumors; unknown primary tumor; Radionuclide study; Human; flourodeoxyglucose; Stomatology; Malignant lymphadenopathy; Malignant hemopathy; ENT; Malignant tumor; Lymph node metastasis; unknown primary tumor; cervical lymph node metastasis; Treatment; Cervical ganglion; ENT disease; Head and neck cancer; Neck; Diagnosis; Detection; Positron emission tomography; Cancer; Emission tomography
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.20734

Background. The benefit of a complementary fluorodeoxyglucose‐positron emission tomography (FDG‐PET) scan to standard workup for carcinoma of unknown primary (CUP) and metastatic neck lesions was prospectively studied. Methods. Sixty‐seven patients underwent standardized diagnostic workup according to national guidelines including panendoscopies, multiple mucosal biopsies, and diagnostic CT/MRI scans. Median follow‐up was 40 months (range, 2–65 months). Results. In 60 eligible patients, FDG‐PET indicated a primary tumor or metastatic disease in 30 patients (50%). Additional investigations confirmed a primary tumor in 18 patients: hypopharynx in 5, oropharynx in 5, nasopharynx in 2, lung in 1, axilla in 1, bone in 1, rectum in 1, as well as multiple metastatic lesions from CUP in 2 patients. In retrospect, MRI was able to detect 1 of the PET‐detected primaries, leading to an overall detection rate of PET of 29% in CUP. A therapeutic change of treatment was made in 25% as a consequence of FDG‐PET. PET before panendoscopy demonstrated fewer false‐positive pathological foci. Conclusion. FDG‐PET is a valuable tool in addition to conventional extensive workup in CUP and neck metastases. Consequently, FDG‐PET is now recommended as an early diagnostic modality in the workup of these patients. © 2007 Wiley Periodicals, Inc. Head Neck, 2008