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Performance of 18F-FDG-PET/CT as a next step in the search of occult primary tumors for patients with head and neck squamous cell carcinoma of unknown primary: a systematic review and meta-analysis

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Abstract

Purpose

We performed a systemic review and meta-analysis to evaluate the performance of 18F-FDG-PET/CT as a next step in the search of occult primary tumors for patients with head and neck squamous cell carcinoma of unknown primary (HNSCC-UP).

Methods

PubMed and Embase databases were searched from the earliest available date of indexing through February 2021. Eligible studies were those using 18F-FDG-PET/CT to detect occult primary tumors for HNSCC-UP, of which the defining diagnostic workup had been limited to endoscopy with or without CT/MRI. The detection rates were meta-analytically pooled using a random-effects model. Subgroup analyses and meta-regression were performed to explore the source of heterogeneity. A pooled analysis evaluating the false-positive proportions was also performed.

Results

Sixteen studies with 724 patients were included in this meta-analysis. The pooled detection rate was 40% (95% CI 31–49%), with high heterogeneity (I2 = 85.2%). No sources of heterogeneity were identified by analyzing multiple subgroups stratified by study design, sample size, ethnicity, use of contrast agent, defining diagnostic workup, image analysis, and reference standard (All P > 0.05). The most common sites of both true-positive cases and false-positive cases were tonsil and tongue base. The pooled false-positive proportion was 9% (95% CI 5–13%).

Conclusions

18F-FDG PET/CT is useful as a next step in the search of occult primary tumors in HNSCC-UP patients defined by endoscopy with or without CT/MRI. However, in light of the high false-positive proportion, confirmatory histological investigations should be viewed as necessary practice upon positive PET/CT findings.

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  1. Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China

    Huo Huasong, Shen Shurui, Gao Shi & Ji Bin

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HH: Literature search and review, meta-analysis. SS: Literature search and review, meta-analysis. GS: Literature review. JB: Content planning, manuscript writing and editing.

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Correspondence to Ji Bin.

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40336_2021_429_MOESM1_ESM.pptx

Supplementary file1 Supplementary Figure 1-2 Quality assessment of the included studies. Supplementary Figure 3 Egger’s test for detection rate. Supplementary Figure 4 Egger’s test for false-positive proportion. (PPTX 784 KB)

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Huasong, H., Shurui, S., Shi, G. et al. Performance of 18F-FDG-PET/CT as a next step in the search of occult primary tumors for patients with head and neck squamous cell carcinoma of unknown primary: a systematic review and meta-analysis. Clin Transl Imaging 9, 361–371 (2021). https://doi.org/10.1007/s40336-021-00429-w

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