Department of Otorhinolaryngology, and Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, 3-9 Fukuura, Yokohama, Kanazawa 236-0004, Japan.
Eur Arch Otorhinolaryngol. 2010 Nov;267(11):1785-92. doi: 10.1007/s00405-010-1371-3. Epub 2010 Sep 3.
The aim of this study was to verify the effectiveness of positron emission tomography (PET) in detecting primary sites in carcinoma of unknown primary (CUP) patients. In this study, CUP represented a group of heterogeneous tumors that shared the clinical manifestation of metastatic carcinoma with no obvious primary site at the time of first diagnosis, which included clinical investigations, computed tomography, magnetic resonance imaging and panendoscopy. We reviewed the records of 24 patients with CUP between January 1995 and December 2009. The patients who demonstrated additional tracer uptake sites other than previously known metastatic lesions by PET scan were done direct biopsies for the sites of accumulation. Patients who had a negative PET scan or for whom the primary site could not be identified by direct biopsies underwent examination under anesthesia of the at-risk occult tumor sites. PET scan demonstrated focal accumulation suspicious for primary tumor in 12 (50.0%) of 24 patients: tonsil 5, nasopharynx 3, hypopharynx 1, tongue 1, larynx 1, and maxillary sinus 1. A subsequent biopsy of these sites revealed primary cancer in 9 (37.5%) of 24 patients: tonsil 5, nasopharynx 1, hypopharynx 1, tongue 1, and maxillary sinus 1. In the remaining three patients, no malignant cells were found by the biopsy of the accumulated area: nasopharynx 2, larynx 1. PET scans increase the yield of primary tumor by 37.5%. The sensitivity, specificity for PET scan were 80.8, 76.9%, respectively. PET scanning is useful in detecting primary cancer of CUP patients.
本研究旨在验证正电子发射断层扫描（PET）在检测未知原发性癌（CUP）患者原发性肿瘤中的有效性。在本研究中，CUP 代表一组具有异质性的肿瘤，这些肿瘤在首次诊断时表现为转移性癌的临床表现，且无明显的原发性肿瘤部位，包括临床检查、计算机断层扫描、磁共振成像和全内镜检查。我们回顾了 1995 年 1 月至 2009 年 12 月间 24 例 CUP 患者的记录。在 PET 扫描中，除先前已知的转移性病变外，显示其他示踪剂摄取部位的患者，对这些部位进行了直接活检。PET 扫描为阴性或无法通过直接活检确定原发性肿瘤部位的患者，进行了隐匿性肿瘤高危部位的麻醉下检查。PET 扫描显示 12 例（50.0%）患者存在可疑原发性肿瘤的局灶性摄取：扁桃体 5 例、鼻咽部 3 例、下咽 1 例、舌 1 例、喉 1 例、上颌窦 1 例。对这些部位进行后续活检，发现 24 例患者中有 9 例（37.5%）存在原发性癌症：扁桃体 5 例、鼻咽部 1 例、下咽 1 例、舌 1 例、上颌窦 1 例。在其余 3 例患者中，活检未发现累积部位的恶性细胞：鼻咽部 2 例、喉 1 例。PET 扫描使原发性肿瘤的检出率增加了 37.5%。PET 扫描的敏感性、特异性分别为 80.8%、76.9%。PET 扫描有助于检测 CUP 患者的原发性癌症。
