Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada.
Head Neck. 2011 Jul;33(7):935-40. doi: 10.1002/hed.21566. Epub 2010 Nov 12.
Metastatic head and neck squamous cell carcinoma with an unknown primary is an uncommon but important problem. PET/CT, as an adjunct to diagnosis, is potentially useful but has never been studied in a prospective, single-blinded clinical trial.
In all, 20 subjects with cervical metastases from an unknown head and neck primary were enrolled in a prospective clinical trial. A standard protocol was used in both clinic and operating room (OR). Study surgeons were blinded to the PET/CT result upon completion of the standard work-up.
PET/CT increased the detection of a primary site from 25% to 55% (5 vs 11 subjects). This difference was statistically and clinically significant (p = .03, McNemar's test). There was 1 false negative PET/CT scan.
An unknown primary should be diagnosed only after a complete head and neck examination, flexible endoscopy, and CT or MRI. PET/CT performed prior to panendoscopy will increase the diagnostic yield in the unknown head and neck primary population, leading to more targeted, and less morbid, treatment.
不明原发灶的转移性头颈部鳞状细胞癌是一种不常见但很重要的问题。PET/CT 作为一种辅助诊断方法具有潜在的作用，但尚未在前瞻性、单盲临床试验中进行研究。
共有 20 例头颈部原发灶不明的颈部转移患者参与了一项前瞻性临床试验。在诊所和手术室（OR）均采用标准方案。研究外科医生在完成标准检查后对 PET/CT 结果进行盲法评估。
PET/CT 将原发灶的检出率从 25%提高到 55%（5 例 vs 11 例）。这一差异具有统计学和临床意义（p =.03，McNemar 检验）。有 1 例 PET/CT 扫描假阴性。
只有在进行全面的头颈部检查、软性内镜检查以及 CT 或 MRI 后，才能诊断不明原发灶。在全内镜检查前进行 PET/CT 检查将提高不明头颈部原发灶人群的诊断率，从而实现更有针对性、更少创伤的治疗。
