title: Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities.
abstract: In 1%-2% of head and neck oncology patients, the only symptom of a malignancy is a positive cervical node. The aim of this study was to compare the value of positron emission tomography using fluorine-18 fluoro-2-deoxy- D-glucose (FDG-PET) and conventional diagnostic modalities (CT and/or MRI, panendoscopy) in detecting unknown primary tumours and distant metastases in patients suffering from such a cervical metastasis. Fifty patients (37 men and 13 women) with cervical metastases of an unknown primary tumour were included. All patients underwent FDG-PET. In addition, CT and/or MRI was obtained and panendoscopy was performed. All clinically known metastases were detected by FDG-PET. The primary tumour could be diagnosed in 16 patients (four primary tumours were detected exclusively by FDG-PET). Seven patients had multiple distant metastases, that in six cases were detected exclusively by FDG-PET. The sensitivity and specificity of FDG-PET for detection of unknown primary tumours were 100% and 94%, respectively. For the conventional diagnostic modalities these values were 92% and 76%. FDG-PET had an exclusive effect on the applied therapy in 20% of the patients referred for diagnosis of an unknown primary tumour. The data obtained in this study strongly support the diagnostic strategy of performing FDG-PET in patients suffering from cervical metastases of an unknown primary tumour before any other diagnostic technique.
authors.affiliation: Department of Oral and Maxillofacial surgery, Groningen University Hospital, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. g.regelink@kchir.azg.nl
authors.forename: Gerreke
authors.initials: G
authors.lastname: Regelink
authors.forename: Jolijn
authors.initials: J
authors.lastname: Brouwer
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: Jan
authors.initials: J
authors.lastname: Pruim
authors.forename: Bernard F A M
authors.initials: BF
authors.lastname: van der Laan
authors.forename: Willem
authors.initials: W
authors.lastname: Vaalburg
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Emile F I
authors.initials: EF
authors.lastname: Comans
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.forename: Jan L N
authors.initials: JL
authors.lastname: Roodenburg
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000556:secondary*; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18