Pattani Kavita M, Goodier Michael, Lilien David, Kupferman Todd, Caldito Gloria, Nathan Cherie-Ann O
Thoracic/Head and Neck Cancers Specialty Section, MD Anderson Cancer Center, Orlando, FL, USA.
Ear Nose Throat J. 2011 Aug;90(8):E16-20. doi: 10.1177/014556131109000818.
We conducted a retrospective review of the records of 23 patients who had been diagnosed with regionally metastatic head and neck squamous cell carcinoma from an unknown primary tumor. Our goal was to assess the utility of panendoscopy in locating the primary tumor in those patients whose positron-emission tomography/computed tomography (PET/CT) findings were negative. Overall, we found that PET/CT had correctly identified the unknown primary in 12 of the 23 patients (52%); panendoscopy confirmed this finding in all 12. Of the remaining 11 patients, however, panendoscopy located the primary tumor in only 1 (9%). In this era of cost containment and ongoing advances in imaging and transnasal esophagoscopy, it is important to revisit the workup of an unknown primary in patients with a negative PET/CT scan. There are various advantages and disadvantages to performing panendoscopy with biopsy in patients with an unknown primary and a negative PET/CT scan, but our results and the findings of others indicate that it will detect the primary in only about 10% of these cases. We recommend careful selection of patients who are to undergo panendoscopy for the routine workup of an unknown primary.
我们对23例被诊断为来自未知原发肿瘤的区域转移性头颈部鳞状细胞癌患者的病历进行了回顾性研究。我们的目标是评估在正电子发射断层扫描/计算机断层扫描（PET/CT）结果为阴性的患者中，全面内镜检查在定位原发肿瘤方面的效用。总体而言，我们发现PET/CT在23例患者中的12例（52%）中正确识别出了未知原发灶；全面内镜检查在这12例中均证实了这一发现。然而，在其余11例患者中，全面内镜检查仅在1例（9%）中定位到了原发肿瘤。在这个成本控制的时代以及成像和经鼻食管镜检查不断进步的背景下，重新审视PET/CT扫描阴性的患者中未知原发灶的检查方法很重要。对于PET/CT扫描阴性且原发灶未知的患者进行全面内镜检查并活检有各种优缺点，但我们的结果以及其他研究结果表明，在这些病例中它仅能在约10%的病例中检测到原发灶。我们建议在为未知原发灶的常规检查而接受全面内镜检查的患者选择上要谨慎。
