Investigation strategy in the management of metastatic adenocarcinoma of unknown primary presenting as cervical lymphadenopathy.
CONCLUSIONS
Computed tomography (CT) of the neck, chest, abdomen and pelvis is the most appropriate initial investigation following a fine needle aspiration cytology (FNAC) diagnosis of metastatic adenocarcinoma in cervical lymph nodes with unknown primary. PET-CT should be considered as the next step if the initial CT fails to identify the primary site, but its true value is yet to be determined.


OBJECTIVE
To review investigation strategies for metastatic adenocarcinoma of unknown primary presenting as cervical lymphadenopathy, and to develop a management algorithm.


METHODS
This was a retrospective case note study from two regional head and neck cancer centres in the UK. Adult patients with FNAC diagnosis of metastatic adenocarcinoma in cervical lymph nodes between 1998 and 2008, with a minimum 5-year follow-up, were included. Patients with a clinically obvious primary tumour or a previous history of adenocarcinoma were excluded.


RESULTS
This study examined 41 cases. CT of the neck, chest, abdomen and pelvis was the most useful initial investigation. It identified the primary tumour site in 16/28 cases (57%), detected the primary tumour and led to revision of the FNAC diagnosis in 1 case (2.4%), and was necessary for the final diagnosis of true unknown primary in 12 cases (29.3%). Targeted imaging was not helpful.
Department of Otolaryngology - Head and Neck Surgery, Royal Surrey County Hospital , Guildford.
Christopher
C
Pepper
Irumee
I
Pai
Ashley
A
Hay
Alastair
A
Deery
Philip
P
Wilson
Peter
P
Williamson
Lisa
L
Pitkin
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary*; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009382:Neoplasms, Unknown Primary; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology
PET; head and neck cancer; lymph nodes