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Role of Whole body PET/CT and Examination under anesthesia with multi-site biopsy in evaluating CUP

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

To evaluate the role of 18FDG-WBPET-CT, Examination under anesthesia (EUA), and multiple-site biopsy in detecting the occult site in head & neck carcinoma of unknown primary (HN-CUP). In this prospective study, 22 patients with diagnosed CUP, after a thorough outpatient endoscopic evaluation of upper airway and radiological evaluation (CT/MRI) that ruled out a primary lesion were included. These patients subsequently underwent whole-body PET-CT and EUA. Based on the presence of suspicious findings ( +) or their absence (−) on 18FDG-WBPET-CT (P) and EUA (E), we divided the patients into 5 groups: P−E−, P−E + , P + E−, P + E + , and P + or E + . All these patients underwent bilateral palatine tonsillectomy, bilateral nasopharyngeal biopsy, and ipsilateral lingual tonsillectomy for identification of occult primary. Out of 22 patients, the primary could be detected in 4 patients (18%) after the workup (three in the oropharynx and one in the hypopharynx, all ipsilateral). 18FDG-PET-CT suspected primaries in 7 patients; biopsy was positive for three (sensitivity-75%, specificity-77%, PPV-43%, NPV-93%). Out of 5 patients, who had suspicious findings on EUA, 3 of the biopsies revealed malignancy (sensitivity-75%, specificity-88%, PPV-60%, NPV-94%). Both PET-CT and EUA when combined, yield a NPV of 100% if both are negative and PPV of 100% when both are positive for suspicious findings. No primary was identified in the absence of a suspicion by PET-CT or EUA. Without a suspicion on 18FDG-WBPET-CT and EUA, there is a limited role of multiple-site biopsies in patients of HN-CUP.

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Acknowledgements

We would like to thank Prem Sagar, Shuchita Singh, Smriti Panda, Shikharani Patel, Darwin Kaushal, Sarthak Tripathy and Bhinyaram Jat for their help.

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Authors and Affiliations

  1. Department of Otorhinolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Anupam Kanodia, Chirom Amit Singh, Pirabu Sakthivel, Kapil Sikka, Rajeev Kumar, Rakesh Kumar, Alok Thakar & Suresh C. Sharma

  2. Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Aanchal Kakkar & Siddhartha Datta Gupta

  3. Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Shamim Ahmad Shamim

  4. Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Ashu Seith Bhalla

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  1. Anupam Kanodia
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  2. Chirom Amit Singh
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  3. Pirabu Sakthivel
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  4. Shamim Ahmad Shamim
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  11. Alok Thakar
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  12. Suresh C. Sharma
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Correspondence to Chirom Amit Singh.

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The authors declare that they have no financial or non-financial conflicts of interest.

Ethical Approval

The study was approved by the institutional ethics committee (ref. ID – IECPG/408/6/2016). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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An informed written consent was obtained from all participating patients included in the study.

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Kanodia, A., Singh, C.A., Sakthivel, P. et al. Role of Whole body PET/CT and Examination under anesthesia with multi-site biopsy in evaluating CUP. Indian J Otolaryngol Head Neck Surg 74 (Suppl 2), 2656–2662 (2022). https://doi.org/10.1007/s12070-020-02268-z

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  • DOI: https://doi.org/10.1007/s12070-020-02268-z

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