title: The role of fluorodeoxyglucose positron emission tomography in cervical lymph node metastases from an unknown primary tumor.
abstract: BACKGROUND
  The authors performed a comprehensive review of the efficacy of fluorodeoxyglucose positron emission tomography (FDG-PET) in the detection of primary tumors in patients with cervical metastases from unknown primary tumors.
  
  
  METHODS
  Sixteen studies (involving a total of 302 patients) published between 1994 and 2003 were reviewed. These studies evaluated the role of FDG-PET in the detection of unknown primary tumors after conventional workup. In all studies, conventional workup included either panendoscopy or computed tomographic/magnetic resonance imaging, and in 10 of 16 studies, both of these diagnostic techniques were performed before diagnosis.
  
  
  RESULTS
  The overall sensitivity, specificity, and accuracy rates of FDG-PET in detecting unknown primary tumors were 88.3%, 74.9%, and 78.8%, respectively. Furthermore, FDG-PET detected 24.5% of tumors that were not apparent after conventional workup. FDG-PET imaging also led to the detection of previously unrecognized metastases in 27.1% of patients (regional, 15.9%; distant, 11.2%). FDG-PET had notably low specificity and a high false-positive rate (39.3%) in the tonsils. In contrast, the false-positive rates for FDG-PET of the base of tongue and hypopharynx were only 21.4% and 8.3%, respectively. FDG-PET exhibited decreased sensitivity to tumors in the base of tongue (81.5%). The sensitivity of this technique at other sites was 90.5%.
  
  
  CONCLUSIONS
  FDG-PET detected primary tumors that went undetected by other modalities in approximately 25% of cases and was sensitive in the detection of previously unrecognized regional or distant metastases in 27% of cases. FDG-PET had low specificity for tonsillar tumors and low sensitivity for base-of-tongue malignancies.
authors.affiliation: Department of Radiation Oncology, Emory Clinic/Emory University, Atlanta, Georgia, USA.
authors.forename: Kyle E
authors.initials: KE
authors.lastname: Rusthoven
authors.forename: Mary
authors.initials: M
authors.lastname: Koshy
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
mesh_terms: D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D009333:Neck; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18