Positron emission tomography in the management of unknown primary head and neck carcinoma.
OBJECTIVE
To assess the role of positron emission tomography (PET) in the management of unknown primary carcinoma of the head and neck region.


METHODS
Prospective case series at an academic medical center.


METHODS
Twenty-six patients with an open excisional biopsy or a fine-needle aspiration biopsy finding that confirmed squamous cell carcinoma of the cervical lymph nodes and no visible primary tumor (as determined by results of a comprehensive physical examination and computed tomography and/or magnetic resonance imaging) underwent PET. The standard evaluation consisted of a comprehensive head and neck examination that included fiberoptic laryngoscopy/nasopharyngoscopy, computed tomography and/or magnetic resonance imaging, and PET followed by panendoscopy with selected biopsies and tonsillectomy.


METHODS
Sensitivity, specificity, and positive and negative predictive values of PET to detect an occult primary tumor.


RESULTS
The PET detected 8 occult primary tumors in 26 patients (detection rate, 30.8%). Four occult primary tumors (2 at the base of the tongue and 2 in the tonsil) were detected during routine panendoscopy with negative PET findings. The sensitivity of PET was 66.0%, with a specificity of 92.9%. The positive predictive value was 88.8%, and the negative predictive value was 76.5%.


CONCLUSIONS
Positron emission tomography can be a valuable tool to identify a subset of patients with an occult primary tumor in the head and neck region. In addition, it can be used to screen for primary tumors below the clavicle. Early identification of the primary tumor may allow for more accurate tumor staging and targeted radiotherapy to minimize adverse effects and complications. A normal PET finding, however, does not eliminate the need for a careful panendoscopy with directed biopsies and tonsillectomy.
Miller
Frank R
FR
Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, 78229-3900, USA. millerfr@uthscsa.edu
Hussey
David
D
Beeram
Mural
M
Eng
Tony
T
McGuff
H Stan
HS
Otto
Randal A
RA
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014062:Tongue Neoplasms / Q000000981:diagnostic imaging; D014067:Tonsillar Neoplasms / Q000000981:diagnostic imaging