Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography.
BACKGROUND
Identification of primary tumor in patients with cervical lymph node metastasis of unknown primary (MUO) has a great impact on therapy approach and potentially on patient prognosis.


OBJECTIVE
To assess the diagnostic accuracy of combined positron emission tomography(PET)/computer tomography (CT) for primary tumor detection in cervical metastases of unknown origin compared to PET, CT, and PET+CT side-by-side evaluation.


METHODS
39 consecutive patients (eight women, 31 men; mean age 59.9 ± 11.2 years) with MUO were enrolled in this study. PET/CT images were obtained 1 hour after injection of 350 MBq of fluorodeoxyglucose. Oral and intravenous contrast agents were administered in all patients to ensure diagnostic CT data. Fused PET/CT data were evaluated for primary tumor detection. Diagnostic accuracy was calculated and compared with CT alone, PET alone, and side-by-side PET+CT evaluation.Statistical analysis of differences in diagnostic performance between the different imaging procedures was based on the McNemar test.


RESULTS
Fused PET/CT depicted the primary tumor in 11 of 39 (28%) patients. In 28(72%) patients, the primary tumor remained occult. CT revealed the primary in five(13%), PET alone in 10 (26%), and side-by-side evaluation of PET+CT in 10 (26%) of 39 patients. Statistical analysis showed no significant differences between the imaging modalities.


CONCLUSIONS
PET, side-by-side PET+CT, and PET/CT revealed similar detection rates for primary tumors in cervical MUO patients. Therefore, cervical metastases of an unknown primary may be assessed with either of these imaging modalities. Detection rates with CT were substantially lower. Thus, inclusion of functional data for assessment of cervical MUO patients must be recommended.
Nassenstein
K
K
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany. kai.nassenstein@uni-due.de
Veit-Haibach
P
P
Stergar
H
H
Gutzeit
A
A
Freudenberg
L
L
Kuehl
H
H
Fischer
M
M
Barkhausen
J
J
Bockisch
A
A
Antoch
G
G
D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009333:Neck; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18