PET/CT and Occult Primary Tumors

Within the past 5 years, F-18 fluorodeoxyglucose (FDG) PET/CT has become one of the more frequent imaging modalities in the management of patients with cancer of unknown primary origin. FDG PET/CT detects more sites of metastasis than other modalities, and in 20% to 40% of cases it discloses the site of the primary tumor. Its exact role is yet to be defined because of a lack of prospective clinical trials comparing the performance of PET/CT with conventional anatomic imaging modalities. This article reviews the available literature, attempts to place PET/CT using F-18–labeled FDG in clinical perspective and compares the combined modality with conventional anatomic imaging technologies.

If the inline PDF is not rendering correctly, you can download the PDF file here.

Dr. Podoloff is a consultant, serves on the advisory board for PET/CT, and is a member of Academic Council for GE Healthcare.

Correspondence: Donald A. Podoloff, MD, The University of Texas M. D. Anderson Cancer Center, Division of Diagnostic Imaging, 1515 Holcombe Boulevard, Unit 0057, Houston, TX 77030. E-mail: dpodoloff@di.mdacc.tmc.edu
  • 1

    Pavlidis N, Briasoulis E, Hainsworth J, Greco FA. Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer 2003;39:19902005.

    • Search Google Scholar
    • Export Citation
  • 2

    Golder WA. Lymph node diagnosis in oncologic imaging: a dilemma still waiting to be solved. Onkologie 2004;27:194199.

  • 3

    Donta TS, Smoker WR. Head and neck cancer: carcinoma of unknown primary. Top Magn Reson Imaging 2007;18:281292.

  • 4

    Basu S, Alavi A. FDG-PET in the clinical management of carcinoma of unknown primary with metastatic cervical lymphadenopathy: shifting gears from detecting the primary to planning therapeutic strategies. Eur J Nucl Med Mol Imaging 2007;34:427428.

    • Search Google Scholar
    • Export Citation
  • 5

    Guntinas-Lichius O, Peter Klussmann J, Dinh S. Diagnostic work-up and outcome of cervical metastases from an unknown primary. Acta Otolaryngol 2006;126:536544.

    • Search Google Scholar
    • Export Citation
  • 6

    Gutzeit A, Antoch G, Kuhl H. Unknown primary tumors: detection with dual-modality PET/CT—initial experience. Radiology 2005;234:227234.

  • 7

    Kolesnikov-Gauthier H, Levy E, Merlet P. FDG PET in patients with cancer of an unknown primary. Nucl Med Commun 2005;26:10591066.

  • 8

    Mevio E, Gorini E, Sbrocca M. The role of positron emission tomography (PET) in the management of cervical lymph nodes metastases from an unknown primary tumor. Acta Otorhinolaryngologica Italica 2004;24:342347.

    • Search Google Scholar
    • Export Citation
  • 9

    Miller FR, Hussey D, Beeram M. Positron emission tomography in the management of unknown primary head and neck carcinoma. Arch Otolaryngol Head Neck Surg 2005;131:626629.

    • Search Google Scholar
    • Export Citation
  • 10

    Nanni C, Rubello D, Castellucci P. Role of 18F-FDG PET-CT imaging for the detection of an unknown primary tumor: preliminary results in 21 patients. Eur J Nucl Med Mol Imaging 2005;32:589592.

    • Search Google Scholar
    • Export Citation
  • 11

    Paul SA, Stoeckli SJ, von Schulthess GK. FDG PET and PET/CT for the detection of the primary tumor in patients with cervical non-squamous cell carcinoma metastasis of an unknown primary. Eur Arch Otorhinolaryngol 2007;264:189195.

    • Search Google Scholar
    • Export Citation
  • 12

    Scott CL, Kudaba I, Stewart JM. The utility of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography in the investigation of patients with disseminated carcinoma of unknown primary origin. Mol Imaging Biol 2005;7:236243.

    • Search Google Scholar
    • Export Citation
  • 13

    Stoeckli SJ, Mosna-Firlejczyk K, Goerres GW. Lymph node metastasis of squamous cell carcinoma from an unknown primary: impact of positron emission tomography. Eur J Nucl Med Mol Imaging 2003;30:411416.

    • Search Google Scholar
    • Export Citation
  • 14

    Wong WL, Saunders M. The impact of FDG PET on the management of occult primary head and neck tumours. Clin Oncol (R Coll Radiol) 2003;15:461466.

    • Search Google Scholar
    • Export Citation
  • 15

    Delgado-Bolton RC, Fernandez-Perez C, Gonzalez-Mate A, Carreras JL. Meta-analysis of the performance of 18F-FDG PET in primary tumor detection in unknown primary tumors. J Nucl Med 2003;44:13011314.

    • Search Google Scholar
    • Export Citation
  • 16

    Seve P, Billotey C, Broussolle C. The role of 2-deoxy-2-[F-18] fluoro-D-glucose positron emission tomography in disseminated carcinoma of unknown primary site. Cancer 2007;109:292299.

    • Search Google Scholar
    • Export Citation
  • 17

    Alberini JL, Belhocine T, Hustinx R. Whole-body positron emission tomography using fluorodeoxyglucose in patients with metastases of unknown primary tumors (CUP syndrome). Nucl Med Commun 2003;24:10811086.

    • Search Google Scholar
    • Export Citation
  • 18

    Fencl P, Belohlavek O, Skopalova M. Prognostic and diagnostic accuracy of [18F]FDG-PET/CT in 190 patients with carcinoma of unknown primary. Eur J Nucl Med Mol Imaging 2007;34:17831792.

    • Search Google Scholar
    • Export Citation
  • 19

    Freudenberg LS, Rosenbaum-Krumme SJ, Bockisch A. Cancer of unknown primary. Recent Results Cancer Res 2008;170:193202.

  • 20

    Garin E, Prigent-Lejeune F, Lesimple T. Impact of PET-FDG in the diagnosis and therapeutic care of patients presenting with metastases of unknown primary. Cancer Invest 2007;25:232239.

    • Search Google Scholar
    • Export Citation
  • 21

    Johansen J, Buus S, Loft A. Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study. Head Neck 2008;30:471478.

    • Search Google Scholar
    • Export Citation
  • 22

    Joshi U, van der Hoeven JJ, Comans EF. In search of an unknown primary tumor presenting with extracervical metastases: the diagnostic performance of FDG-PET. Br J Radiol 2004;77:10001006.

    • Search Google Scholar
    • Export Citation
  • 23

    Miller FR, Karnad AB, Eng T. Management of the unknown primary carcinoma: long-term follow-up on a negative PET scan and negative panendoscopy. Head Neck 2008;30:2834.

    • Search Google Scholar
    • Export Citation
  • 24

    Stoeckli SJ, Mosna-Firlejczyk K, Goerres GW. Lymph node metastasis of squamous cell carcinoma from an unknown primary: impact of positron emission tomography. Eur J Nucl Med Mol Imaging 2003;30:411416.

    • Search Google Scholar
    • Export Citation
  • 25

    Wartski M, Le Stanc E, Gontier E. In search of an unknown primary tumor presenting with cervical metastases: performance of hybrid FDG-PET-CT. Nucl Med Commun 2007;28:365371.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 36 26 2
PDF Downloads 26 25 6
EPUB Downloads 0 0 0