Abstract
In patients with a neck metastasis from an unknown primary with non-squamous cell cancer (non-SCC) histology, the primary is often located outside the head and neck area. We retrospectively evaluated 326 patient records and found 14 patients with non-SCC neck lymph node metastasis from an unknown primary undergoing whole body F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) with or without coregistered computed tomography (PET/CT). The PET or PET/CT findings were verified by pathological work-up, additional imaging tests, and clinical follow-up. PET detected pathological FDG uptake suspicious for the primary in eight patients. PET or PET/CT findings were true positive in seven patients, true negative in 4, false positive in 1, and false negative in two patients. In one patient PET/CT revealed a synchronous ovarian carcinoma. The results suggest that whole body imaging with FDG PET and PET/CT can be useful to identify unknown primaries of non-SCC origin. However, the work-up of patients undergoing PET or PET/CT in our study was very heterogeneous and the primary was more likely found in patients without extensive imaging before PET scanning. Further studies should evaluate if the histology of a neck nodal metastasis should influence the choice of the imaging method and the role of PET and PET/CT imaging for the work up of patients with a non-SCC neck lymph node metastasis of an unknown primary.
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Fogarty GB, Peters LJ, Stewart J, Scott C, Rischin D, Hicks RJ (2003) The usefulness of fluorine 18-labelled deoxyglucose positron emission tomography in the investigation of patients with cervical lymphadenopathy from an unknown primary tumor. Head Neck 25(2):138–145
Regelink G, Brouwer J, de Bree R et al (2002) Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG–PET versus conventional modalities. Eur J Nucl Med Mol Imaging 29(8):1024–1030
Jungehulsing M, Scheidhauer K, Pietrzyk U, Eckel H, Schicha H (1999) Detection of unknown primary cancer with fluor-deoxy-glucose positron emission tomography. Ann Otol Rhinol Laryngol 108(6):623–626
Safa AA, Tran LM, Rege S et al (1999) The role of positron emission tomography in occult primary head and neck cancers. Cancer J Sci Am 5(4):214–218
Bohuslavizki KH, Klutmann S, Kroger S et al (2000) FDG PET detection of unknown primary tumors. J Nucl Med 41(5):816–822
Lassen U, Daugaard G, Eigtved A, Damgaard K, Friberg L (1999) 18F-FDG whole body positron emission tomography (PET) in patients with unknown primary tumours (UPT). Eur J Cancer 35(7):1076–1082
Braams JW, Pruim J, Kole AC et al (1997) Detection of unknown primary head and neck tumors by positron emission tomography. Int J Oral Maxillofac Surg 26(2):112–115
Mendenhall WM, Mancuso AA, Amdur RJ, Stringer SP, Villaret DB, Cassisi NJ (2001) Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site. Am J Otolaryngol 22(4):261–267
Mendenhall WM, Mancuso AA, Parsons JT, Stringer SP, Cassisi NJ (1998) Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 20(8):739–744
Jones AS, Phillips DE, Helliwell TR, Roland NJ (1993) Occult node metastases in head and neck squamous carcinoma. Eur Arch Otorhinolaryngol 250(8):446–449
Wang RC, Goepfert H, Barber AE, Wolf P (1990) Unknown primary squamous cell carcinoma metastatic to the neck. Arch Otolaryngol Head Neck Surg 116(12):1388–1393
Hainsworth JD, Greco FA (1993) Treatment of patients with cancer of an unknown primary site. N Engl J Med 329(4):257–263
Kirschner MJ, Fietkau R, Waldfahrer F, Iro H, Sauer R (1997) Therapy pf cervical lymph node metastases of unknown primary tumor. Strahlenther Onkol 173(7):362–368
Stoeckli SJ, Mosna-Firlejczyk K, Goerres GW (2003) Lymph node metastasis of squamous cell carcinoma from an unknown primary: impact of positron emission tomography. Eur J Nucl Med Mol Imaging 30(3):411–416
Schumacher T, Brink I, Mix M et al (2001) FDG–PET imaging for the staging and follow-up of small cell lung cancer. Eur J Nucl Med 28(4):483–488
Otsuka H, Graham MM, Kogame M, Nishitani H (2005) The impact of FDG–PET in the management of patients with salivary gland malignancy. Ann Nucl Med 19(8):691–694
Hujala K, Martikainen P, Minn H, Grenman R (1993) Malignant nerve sheath tumors of the head and neck: four case studies and review of the literature. Eur Arch Otorhinolaryngol 250(7):379–382
Ferner RE, Lucas JD, O’Doherty MJ et al (2000) Evaluation of (18)fluorodeoxyglucose positron emission tomography ((18)FDG PET) in the detection of malignant peripheral nerve sheath tumours arising from within plexiform neurofibromas in neurofibromatosis 1. J Neurol Neurosurg Psychiatr 68(3):353–357
Lybak S, Olofsson J (2005) Ultrasound of the abdomen and total bone scintigraphy in patients with cancer of the head and neck. Eur Arch Otorhinolaryngol 262(11):887–889
Goerres GW, Schmid DT, Gratz KW, von Schulthess GK, Eyrich GK (2003) Impact of whole body positron emission tomography on initial staging and therapy in patients with squamous cell carcinoma of the oral cavity. Oral Oncol 39(6):547–551
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Paul, S.A.M., Stoeckli, S.J., von Schulthess, G.K. et al. FDG PET and PET/CT for the detection of the primary tumour in patients with cervical non-squamous cell carcinoma metastasis of an unknown primary. Eur Arch Otorhinolaryngol 264, 189–195 (2007). https://doi.org/10.1007/s00405-006-0177-9
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DOI: https://doi.org/10.1007/s00405-006-0177-9