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First published September 2000

2[18F]-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography is a Sensitive Tool for the Detection of Occult Primary Cancer (Carcinoma of Unknown Primary Syndrome) with Head and Neck Lymph Node Manifestation

Abstract

BACKGROUND: The neck lymph nodes are a common site of metastases from carcinoma of unknown primary (CUP syndrome). 2[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (18-FDG-PET) has been shown to be a sensitive tool for detecting primary malignant lesions as well as metastatic spread. We have prospectively investigated the sensitivity of 18-FDG-PET in detecting occult primary carcinomas with manifestation in the head and neck lymph nodes.
METHODS: From May 1994 to July 1998, in 723 patients a cancer of the head and neck was diagnosed at the University of Cologne ENT outpatient clinic. The routinely performed staging procedures were chest radiography; full blood count; cervical and liver ultrasound; endoscopy of the nasopharynx, oropharynx, hypopharynx, larynx, and esophagus; and laboratory analyses. After the staging workup, in 27 of 723 patients (3.7%) CUP syndrome had to be presumed because the primary cancer could not be detected. In these patients 18-FDG-PET was performed, and images were reconstructed with a transmission-emission fusion technique.
RESULTS: In 7 of 27 patients (26%) 18-FDG-PET revealed an unknown primary: in 2 a bronchial carcinoma, in 2 a nasopharyngeal carcinoma, in 1 a squamous cell carcinoma of the parotid gland, in 1 a squamous cell carcinoma of the hypopharynx, and in 1 a carcinoma of the tonsil. In 4 of 7 patients the occult primary tumor was removed surgically. In 8 of 27 patients therapeutic strategy was changed as a result of the 18-FDG-PET findings.
CONCLUSION: 18-FDG-PET should be performed in all patients with CUP syndrome after conventional diagnostic workup fails to identify the primary.

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REFERENCES

Abbruzzese JL, Abbruzzese MC, Hess KR, et al. Unknown primary carcinoma: Natural history and prognostic factors in 657 consecutive patients. J Clin Oncol 1994; 12:1272–80.
Muir C. Cancer of unknown primary site. Cancer 1995; 75:353–6.
Jungehülsing M, Eckel HE, Staar S, et al. Diagnosis and therapy of occult primary tumor with lymph node metastases in the area of the head and neck [in German]. HNO 1997; 45:573–83.
Abrams HL, Spiro RH, Goldstein M. Metastases in carcinoma. Analysis of 1000 autopsied cases. Cancer 1950; 3:120–4.
Mackay B, Ordonez Ng. Pathological evaluation of neoplasms with unknown primary tumor site. Semin Oncol 1993; 20:206–28.
Abbruzzese JL, Abbruzzese MC, Lenzi R, et al. Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin. J Clin Oncol 1995; 13:2094–103.
Subramanian R, Chilla R. Halsymphknotenmetastasen bei unbekanntem Primartumor. Verlaufsbeobachtung an 58 Patienten [Cervical lymph node metastases in unknown primary tumor. Follow-up of 58 patients]. HNO 1995; 43:299–303.
Leskinen S, Lapela M, Lindholm P, et al. Metabolic imaging by positron emission tomography in oncology. Ann Med 1997; 29:271–4.
Hawkins RA, Hoh Ck. PET FDG studies in oncology. Nucl Med Biol 1994; 21:739–47.
Byers Rm. Neck dissection: Concepts, controversies, and technique. Semin Surg Oncol 1991; 7:9–13.
Lefebvre JL, Coche-Dequeant DB, Van JT, et al. Cervical lymph nodes from an unknown primary tumor in 190 patients. Am J Surg 1990; 160:443–6.
Hamacher K, Coenen HH, Stöcklin G. Efficient stereospecific synthesis of non-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986; 27:235–8.
Pietrzyk U, Herholz K, Schuster A, et al. Clinical applications of registration and fusion of multimodality brain images from PET, SPECT, CT, and MRI. Eur J Radiol 1996; 21:174–82.
Medina Je. A rational classification of neck dissections. Otolaryngol Head Neck Surg 1989; 100:169–76.
Keyes JWJr, Watson NEJr, Williams DW3rd, et al. FDG PET in head and neck cancer. AJR Am J Roentgenol 1997; 169:1663–9.
Bailet JW, Abemayor E, Jabour BA, et al. Positron emission tomography: A new, precise imaging modality for the detection of primary head and neck tumors and assessment of cervical adenopathy. Laryngoscope 1992; 102:281–8.
Jabour B, Choy Y, Hoh CK, et al. Extracranial head and neck: PET imaging with 2-[F-18]fluoro-2-deoxy-D-glucose and MR imaging correlation. Radiology 1993; 186:27–35.
Braams JW, Pruim J, Freling Mjm. Detection of lymph node metastases of squamous cell cancer of the head and neck with FDG-PET and MRI. J Nucl Med 1995; 36:211–6.
Greven KM, Williams DW3rd, Keyes JWJr, et al. Can positron emission tomography distinguish tumor recurrence from irradiation sequelae in patients treated for larynx cancer? Cancer J Sci Am 1997; 3:353–7.
Haberkorn U, Strauss LG, Reisser C, et al. Positron emission tomography (PET) in the evaluation of tumor proliferation and follow-up of therapy in ear, nose and throat tumors [in German]. Radiologe 1992; 32:296–301.
Hoh CK, Dahlbom M, Hawkins RA, et al. Basic principles of positron emission tomography in oncology: Quantitation and whole body techniques. Wien Klin Wochenschr 1994; 106:496–504.
Wahl RL, Cody RL, Hutchins GD, et al. Primary and metastatic breast carcinoma: Initial clinical evaluation with PET with the radiolabeled glucose analogue 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1991; 179:765–70.
Braams JW, Pruim J, Kole AC, et al. Detection of unknown primary head and neck tumors by positron emission tomography. Int J Oral Maxillofac Surg 1997; 26:112–5.
Kole AC, Nieweg OE, Pruim J, et al. Detection of unknown occult primary tumors using positron emission tomography. Cancer 1998; 82:1160–6.
Schipper JH, Schrader M, Arweiler D, et al. Positron emission tomography for primary tumor detection in lymph node metastases with unknown primary tumor [in German]. HNO 1996; 44:254–7.
Abbruzzese JL, Raber MN, Frost P. An effective strategy for the evaluation of unknown primary tumors. Cancer Bull 1988; 41:157–61.
Wang RC, Goepfert H, Barber AE, et al. Unknown primary squamous cell carcinoma metastatic to the neck. Arch Otolaryngol Head Neck Surg 1990; 116:1388–93.
Abbuzzese JL, Lenzi R, Raber MN, et al. The biology of unknown primary tumors. Semin Oncol 1993; 20:238–43.
Frost P, Levin B. Clinical implications of metastatic process. Lancet 1992; 339:1458–61.
Frost P. Unknown primary tumors: An example of accelerated (type 2) tumor progression. Basic Life Sci 1991; 57:233–7.
Knobber D, Lobeck H, Steinkamp Hj. Gibt es die malignisierte laterale Halszyste doch? [Does malignant lateral cervical cyst still exist?] HNO 1995; 43:104–7.
Devine Kd. Cancer in the neck without obvious source. Mayo Clin Proc 1978; 53:644–9.
Ridenhour CE, Yeun PF, Spratt Js. Metastatic carcinoma in cervical lymph nodes from occult primary sites. A review. Mo Med 1967; 64:988–93.
Kole AC, Nieweg OE, Pruim J, et al. Detection of unknown occult primary tumors using positron emission tomography. Cancer 1998; 82:1160–6.
Adler LP, Faulhaber PF, Schnur KC, et al. Axillary lymph node metastases: Screening with [F-18]2-deoxy-2-fluoro-D-glucose (FDG) PET. Radiology 1997; 203:323–7.
Scott WJ, Gobar LS, Hauser LG, et al. Detection of scalene lymph node metastases from lung cancer. Positron emission tomography published erratum appears in Chest 1995; 107:1776. Chest 1995; 107:1174–6.

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Article first published: September 2000
Issue published: September 2000

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History

Issue published: September 2000
Published online: September 1, 2016
PubMed: 10964310

Authors

Affiliations

Dr. Markus Jungehulsing, MD
Cologne, Germany
From the ENT (Drs Jungehülsing, Damm, Eckel, and Stennert)
Dr. Klemens Scheidhauer, MD
Cologne, Germany
Nuclear Medicine (Drs Scheidhauer and Schicha) and Departments, University of Cologne;
Dr. Michael Damm, MD
Cologne, Germany
From the ENT (Drs Jungehülsing, Damm, Eckel, and Stennert)
Dr. Uwe Pietrzyk, Phd
Cologne, Germany
and the Max Planck Institute for Neurologic Research (Dr Pietrzyk).
Dr. Hans Eckel, MD
Cologne, Germany
From the ENT (Drs Jungehülsing, Damm, Eckel, and Stennert)
Dr. Harald Schicha, MD
Cologne, Germany
Nuclear Medicine (Drs Scheidhauer and Schicha) and Departments, University of Cologne;
Dr. Eberhard Stennert, MD
Cologne, Germany
From the ENT (Drs Jungehülsing, Damm, Eckel, and Stennert)

Notes

Reprint requests: M. Jungehülsing, MD, Universitäts-Hals-, Nasen-, Ohrenklinik, 50924 Cologne, Germany.
Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, San Antonio, TX, September 13–16, 1998.

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