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FDG PET/CT and Conventional Imaging Methods in Cancer of Unknown Primary: an Approach to Overscanning

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Abstract

Purpose

To compare the performance of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) with conventional imaging methods (CIM), including computed tomography (CT), magnetic resonance imaging (MRI), and mammography (MMG) in cancer of unknown primary (CUP).

Methods

A total of 36 patients with CUP, who referred to our clinic for a FDG PET/CT scan, were enrolled in this study. Thirty of the patients were also examined through either diagnostic CT/MRI and/or MMG. The diagnostic performance of both methods for the primary cancer location was analyzed. The results of FDG PET/CT and CIM were compared based on the standard reference of the histopathology and/or clinical and laboratory follow-up.

Results

The primary cancer locations were detected in 24 patients (66.6%, 24/36) by FDG PET/CT, whereas CIM identified the locations in 16 patients (53.3%, 16/30). Sensitivity, specificity, PPV, NPV, and accuracy rates of the detection of the primary tumor localizations were as follows: 83, 70, 89, 58, and 79% for FDG PET/CT; 70, 62, 84, 42, and 68% for CIM, respectively. There was no statistical significance between modalities regarding any of the categories in 30 patients.

Conclusion

FDG PET/CT detected the primary tumors of the patients with CUP more than CIM did. However, the difference between them was not found to be statistically significant. It may be considered that FDG PET/CT scan can be performed as a first-line tool in the initial diagnosis of the patients with CUP and to add radiodiagnostic imaging in selective cases. We conclude that if the first-line examination of a CUP patient has been already performed by a CIM and the result was negative or inconclusive, FDG PET/CT can be considered to avoid unnecessary imaging procedures.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey

    Neslihan Cetin Avci

  2. Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey

    Filiz Hatipoglu & Emine Ebru Bayar

  3. Department of Internal Medicine and Oncology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey

    Ahmet Alacacıoglu

  4. Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey

    Gonca Gul Bural

Authors
  1. Neslihan Cetin Avci
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  2. Filiz Hatipoglu
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  3. Ahmet Alacacıoglu
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  4. Emine Ebru Bayar
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  5. Gonca Gul Bural
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Corresponding author

Correspondence to Neslihan Cetin Avci.

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Conflict of Interest

Neslihan Cetin Avci, Filiz Hatipoglu, Ahmet Alacacıoglu, Emine Ebru Bayar, and Gonca Gul Bural declare that they have no conflict of interest or no fundings received.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

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Cetin Avci, N., Hatipoglu, F., Alacacıoglu, A. et al. FDG PET/CT and Conventional Imaging Methods in Cancer of Unknown Primary: an Approach to Overscanning. Nucl Med Mol Imaging 52, 438–444 (2018). https://doi.org/10.1007/s13139-018-0544-7

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  • DOI: https://doi.org/10.1007/s13139-018-0544-7

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