Zusammenfassung
Problem
Wenn bei metastasierten Tumorerkrankungen kein offensichtlicher Primärtumor nachweisbar ist („cancer of unknown primary“, CUP), sollte dieser dennoch möglichst identifiziert werden, da eine spezifische Therapie bessere Resultate erzielt als eine empirische, palliative Behandlung.
Methodik
Die neue Leitlinie der European Society of Medical Oncology (ESMO) definiert Algorithmen zur Abklärung bei CUP-Syndrom, bei denen radiologische und nuklearmedizinische Bildgebungsverfahren eine zentrale Stellung einnehmen. Wichtige Hinweise auf einen möglichen Primärtumor sind Größe und Morphologie von Herden und das Vorliegen einer dominanten Läsion, ebenso das Muster von hämatogen metastatisch befallenen Organen sowie die anatomische Verteilung befallener Lymphknoten.
Schlussfolgerung
Bei Patienten mit Metastasen spielt beim Auffinden eines möglichen Primärtumors die bildgebende Diagnostik eine wichtige Rolle, aber die Befunde müssen in Kenntnis der klinischen und immunhistochemischen Befunde erhoben werden. In schwierigen Fällen sollte interdisziplinär zwischen Referenzonkologie, -radiologie und -pathologie über das Vorliegen eines CUP-Syndroms beraten werden.
Abstract
Problem
If no obvious primary tumour is detectable in metastatic tumours (cancer of unknown primary, CUP), it should nevertheless be identified if possible, as specific therapy achieves better results than empirical, palliative treatment of CUP.
Methodology
The new guideline of the European Society of Medical Oncology (ESMO) defines algorithms for the evaluation of CUP, in which radiological and nuclear imaging procedures play a central role. Important clues to a possible primary tumour are the size and morphology of foci and the presence of a dominant lesion, as well as the pattern of hematogeneous metastatic spread in affected organs, and the anatomical distribution of affected lymph nodes.
Conclusion
In patients with metastases, imaging plays an important role in identifying a possible primary tumour, but the diagnosis must be made with knowledge of the clinical and immunohistochemical results. In difficult cases, there should be interdisciplinary consultation between reference oncology, radiology, and pathology on the presence of CUP.
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F.T. Kurz und S. Delorme geben an, dass kein Interessenkonflikt besteht.
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Kurz, F.T., Delorme, S. Radiologische Bildgebung beim CUP-Syndrom. Radiologie 63, 346–353 (2023). https://doi.org/10.1007/s00117-023-01145-4
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DOI: https://doi.org/10.1007/s00117-023-01145-4