Author/Editor		Bohuslavizki, Karl H; Klutmann, Susane; Buchert, Ralph; Kroeger, Sabine; Werner, Jochen A; Mester, Janos; Clausen, Malte
Title		Value of F-18-FDG PET in patients with cervical lymph node metastases of unknown origin
Translated title		Pomen preiskave s F-18-FDG PET pri bolnikih z mestazami v vratnih bezgavkah neznanega izvora
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 33, št. 3
Publication year		1999
Volume		str. 207-13
Language		eng
Abstract		Background. Cancer of unknown primary is still a major diagnostic problem in patients with lymph node metastases despite a large variety of imaging modalities. Therefore, the aim of this study was to evaluate the impact of F-18-FDG positron emission tomography (PET) in these patients. Materials and methods. A total of 28 patients aged 39 to 84 years with cervical lymph node metastases of squamous cell carcinoma (n=24) or an undifferentiated carcinoma (n=4) were investigated. Prior to PET a complete history, physical examination, ultrasound of the neck, panendoscopy, and CT of the head and neck region were performed in all patients without detection of the primary tumour site. All patients received 370 MBq F-18-FDG intravenously, and whole-body images were acquired at 60 min p.i. using an ECAT EXACT 47 (921) (Siemens, CTI). All lesions were evaluated either by histology or by subsequent CT/MRL Results. In 16/28 patients PET showed focal tracer accumulations corresponding to potential primary tumour sites located in the lungs (n=7), in the region of the palatine tonsil (n=5), the submandibular gland (n=1), the nasopharynx (n=1), the larynx (n=1), and at the base of the tongue (n=1). In 9 out of tlsese 16 patients the primary tumour could be confirmed in the lungs (n=5), in the larynx, at the base of the tongue, the nasopharynx and the palatine tonsil in one patient each, respectively. In 6/16 patients PET lesions were false positive, predominantly located in the palatine tonsil (n=3). One patient denied further evaluation of PET findings. However, in 12/28 patients PET did not reveal tumour-suspicious lesions. Conclusions. Since F-18-FDG PET detected the primary tumour site in approximately one third of the patients with cervical node metastases from an unknown primary (CUP-syndrome), F-18-FDG PET is a valuable diagnostic tool which might help to select a potentially curative treatment protocol in these patients.
Summary		Izhodišča. Čeprav imamo danes več možnosti slikovne diagnostike, predstavljo metastaze neznanega izvora še vedno velik diagnostičen problem. Zato je bil namen naše studije opredeliti pri teh bolnikih pomen preiskave s fluor-18-fluorodeoksiglukozo (F-18-FDG) in pozitronsko emisijsko tomografijo (PET). Material in metode. Obravnavali smo 28 bolnikov, starih od 39 do 84 let, od katerih jih je imelo 24 v vratnih bezgavkah metastaze skvamozno celičnega karcinoma, 4 pa metastaze nediferenciranega karcinoma. Pri vseh bolnikih smo naredili klinični pregled, ultrazvočno preiskavo vratu in CT glave. Ker nismo uspeli odkriti primarnega tumorja, smo se odločili za preiskavo s PET. Vsem bolnikom smo intravenozno aplicirali 370 MBq F-18- FDG, po 60. minutah pa smo naredili tomografski posnetek celega telesa z aparatom ECAT EXACT 47 (921) (Siemens, CTI). Lezije, ki smo jih odkrili s PET-om, smo skušali pri vseh bolnikih oceniti tudi histološko ali s CT/MRI. Rezultati. Pri 16 od 28 bolnikih je PET pokazal žarišča kopičenja radiofarmaka, ki so ustrezala potencialnim primarnim ležiščem tumorja; pri 7 bolnikih v pljučih, pri 5 v tonzilah, po 1 bolnik pa je imel takšno žarišče v submandibularni žlezi, v nazofarinksu, v larinksu in v bazi jezika. Primarni tumor smo uspeli potrditi pri 9 od omenjenih 16 bolnikih; od tega 5 v pljučih, po enega pa v tonzili, v nazofarinksu, larinksu in v bazi jezika. Tako je pri 6 od 16 bolnikih preiskava dala lažno pozitiven rezultat, največkrat v tonzilah, to je pri 3 bolnikih, en bolnik pa je odklonil nadaljnjo evaluacijo, s katero bi potrdili ali ovrgli rezultat preizkave s PET. Pri preostalih 12 od 28 bolnikih priskava PET ni pokazala za primarni tumor sumljivih lezij. Zaključki. S preiskavo F-18-FDG PET lahko primarni tumor odkrijemo približno pri tretjini bolnikov z metastazami na vratu neznanega izvora (CUP-sindrom), zato lahko omenjeno preiskavo pri teh bolnikih smatramo za pomembno pomoč pri izbiri ustreznega zdravljenja.
Descriptors		NEOPLASMS, UNKNOWN PRIMARY LYMPHATIC METASTASIS TOMOGRAPHY, EMISSION-COMPUTED NECK FLUORINE RADIOISOTOPES LUNG NEOPLASMS MOUTH NEOPLASMS