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Intérêt de la tomographie d’émission de positons au 18F-fluorodésoxyglucose (TEP-FDG) dans la prise en charge des syndromes CAPI

Usefulness of FDG-PET in the management of carcinoma of unknown primary

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Oncologie

Abstract

FDG-PET has proven to be a valuable diagnostic tool in patients with a carcinoma of unknown primary. In patients presenting with cervical metastases of unknown primary, FDG-PET makes it possible to locate a primary in 36% of the patients and induces therapeutic modification in 39%. This examination should be carried out prior to upper endoscopy, guiding the biopsies when possible. In patients presenting with non-cervical metastases, FDG-PET localize the primary in 37% of cases, with an impact on the therapeutic management in 42% of the patients. Recent results from coupled PETCT-scanning examinations seem to improve the diagnostic performances this assessment modality, especially its specificity. The prognostic value of FDG-PET still needs to be evaluated.

Résumé

La TEP-FDG présente de façon indiscutable un intérêt dans la prise en charge des patients présentant un syndrome CAPI. Pour les CAPI avec métastases cervicales, la TEP-FDG permet de localiser le primitif pour 36 % des patients et entraîne une modification thérapeutique dans 39 % des cas. La TEP-FDG devrait être réaliseé avant la pan-endoscopie. Cela permet de diriger les biopsies. Par ailleurs, la réalisation de la TEP-FDG après la pan-endoscopie augmente fortement le risque de faux positif. Pour les patients qui présentent des métastases autres que cervicales, la TEP-FDG permet de localiser le primitif en moyenne dans 37 % des cas, de localiser la présence d’une extension métastatique plus importante chez 42 % des patients et induit une modification thérapeutique pour 35 % des patients. Dans cette indication, la TEP-FDG semble plus intéressante dans les formes localise és que multifocales où l’identification d’un primitif est plus délicate et l’impact thérapeutique moins important. L’apparition récente des études couplées TEPCT semble améliorer discrètement la sensibilit’ede cet examen et surtout en améliorer significativement la spécificité. Enfin, l’intérêt pronostique de la TEP-FDG dans cette catégorie de patients reste à être précisé.

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Authors and Affiliations

  1. Service de médecine nucléaire, centre Eugène-Marquis, avenue Bataille-Flandres-Dunkerque, F-35042, Rennes, France

    E. Garin

  2. Service d’oncologie, centre Eugène-Marquis, avenue Bataille-Flandres-Dunkerque, F-35042, Rennes, France

    T. Lesimple

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  1. E. Garin
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Correspondence to E. Garin.

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Garin, E., Lesimple, T. Intérêt de la tomographie d’émission de positons au 18F-fluorodésoxyglucose (TEP-FDG) dans la prise en charge des syndromes CAPI. Oncologie 10, 707–712 (2008). https://doi.org/10.1007/s10269-008-0988-y

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  • DOI: https://doi.org/10.1007/s10269-008-0988-y

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