Chen Yue-Hong, Yang Xin-Ming, Li Shi-Sheng, Wang Yuan-Hua, He Jian-Jun, Yang Yi-Da, Wang Shuang, Liu Jia-Jia, Zhang Xiao-Li
Department of Otolaryngology, Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
J Med Imaging Radiat Oncol. 2012 Feb;56(1):66-74. doi: 10.1111/j.1754-9485.2011.02331.x.
Identification of the primary tumour can prolong the life expectancy of patients with primary unknown cervical lymph node metastasis (PUCLNM) through targeted therapy. This study investigated the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) at identifying primaries in patients with PUCLNM.
Twenty-seven patients (21 males and 6 females, median age 48.2 ± 16.3, age range 30-73) with PUCLNM underwent FDG PET-CT to search for the primary tumour, which could not be detected by conventional diagnostic modalities. The results were analysed and correlated with either pathological findings or clinical follow up.
Pathological FDG uptake suspicious for the primary was detected in 13 cases, while the primary tumour remained occult in 14 cases. Eleven of 13 patients with suspected primaries were confirmed by histological findings. One with a coexisting second tumour and three with unexpected distant metastases were found in patients with confirmed primaries. The most common primary location in patients with PUCLNM found in our study was nasopharynx. In those 14 patients with negative FDG PET-CT results, only one patient had a primary malignancy that was proven histologically after endoscopy with biopsy during a period of clinical follow up. The sensitivity, specificity, accuracy and positive predictive values of FDG PET-CT were 91.7, 86.7, 88.9 and 84.6%, respectively.
FDG PET-CT is a useful tool to help search for unknown primaries in patients with cervical lymph node metastasis and has an acceptable diagnostic yield for the detection of distant malignancies.
明确原发肿瘤可通过靶向治疗延长原发灶不明的颈部淋巴结转移（PUCLNM）患者的预期寿命。本研究探讨18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET-CT）在识别PUCLNM患者原发灶方面的价值。
27例（21例男性和6例女性，中位年龄48.2±16.3岁，年龄范围30 - 73岁）PUCLNM患者接受FDG PET-CT检查以寻找常规诊断方法无法检测到的原发肿瘤。对结果进行分析，并与病理结果或临床随访结果相关联。
13例检测到可疑为原发灶的病理性FDG摄取，而14例患者的原发肿瘤仍隐匿未发现。13例疑似原发灶的患者中有11例经组织学检查得以证实。在确诊原发灶的患者中发现1例合并第二肿瘤，3例出现意外远处转移。本研究中发现的PUCLNM患者最常见的原发部位是鼻咽部。在14例FDG PET-CT结果为阴性的患者中，只有1例患者在临床随访期间经内镜活检组织学证实存在原发性恶性肿瘤。FDG PET-CT的敏感性、特异性、准确性和阳性预测值分别为91.7%、86.7%、88.9%和84.6%。
FDG PET-CT是帮助寻找颈部淋巴结转移患者不明原发灶的有用工具，对检测远处恶性肿瘤具有可接受的诊断率。
