Nuclear Medicine Resident at University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52246, USA.
Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India.
Clin Imaging. 2021 Oct;78:262-270. doi: 10.1016/j.clinimag.2021.06.022. Epub 2021 Jun 19.
To explore the diagnostic performance of F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) to detect the primary tumor site in patients with extracervical metastases from carcinoma of unknown primary (CUP). We evaluated patient outcomes as overall survival (OS).
In a single-center, retrospective study (2005-2019), patients with extracervical metastases from CUP underwent FDG PET/CT to detect primary tumor sites. The final diagnosis was based on histopathology/or clinical follow-up of at least 12 months.
A total of 83 patients [Male 41 (49%), mean age 59 ± 14 years, range: 32-83 years] fulfilled the inclusion/exclusion criteria and were enrolled for analysis. The primary tumor was detected in 36 out of 83 (43%) patients based on histopathology/or clinical follow-up. PET/CT suggested the primary tumor site in 39 (47%) patients with diagnostic accuracy of 87%, sensitivity 89%, specificity 85%, PPV 82%, NPV 91% and detection rate 39%. Patients with oligometastases (<3) (2.16 years, 1.04-2.54) and primary unidentified (1 year, 0.34-2.14) had longer median survival time compared to the patients with multiple metastases (0.67 years, 0.17-1.58, p = 0.009) and primary identified (0.67 years,0.16-1.33, p = 0.002). The SUVmax of the primary or metastatic lesions with maximum uptake was not significantly related to survival.
PET/CT could reveal the primary tumor site in 39% of the patients. It demonstrated the metastatic disease burden and distribution in patients with 'primary obscured', which directs management. Patients with multiple metastases and primary identified had a poorer prognosis. In patients with primary unidentified after PET/CT, a further search was futile.
探讨氟-18 氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）在检测不明原发灶（CUP）宫颈癌颈外转移患者原发灶中的诊断性能。我们评估了患者的总体生存率（OS）。
在一项单中心回顾性研究（2005-2019 年）中，对颈外转移的 CUP 患者进行 FDG PET/CT 以检测原发灶。最终诊断基于组织病理学/或至少 12 个月的临床随访。
共有 83 名患者[男性 41 名（49%），平均年龄 59±14 岁，范围 32-83 岁]符合纳入/排除标准并被纳入分析。根据组织病理学/或临床随访，36 名患者（43%）中检测到原发肿瘤。PET/CT 在 39 名患者（47%）中提示了原发肿瘤部位，诊断准确率为 87%，灵敏度为 89%，特异性为 85%，阳性预测值为 82%，阴性预测值为 91%，检出率为 39%。寡转移（<3 个）（2.16 年，1.04-2.54）和原发灶不明（1 年，0.34-2.14）患者的中位生存时间长于多发转移（0.67 年，0.17-1.58，p=0.009）和原发灶确定（0.67 年，0.16-1.33，p=0.002）患者。原发灶或最大摄取转移灶的 SUVmax 与生存无显著相关性。
PET/CT 可在 39%的患者中发现原发灶。它显示了“原发灶隐匿”患者的转移疾病负担和分布，从而指导治疗。多发转移和原发灶明确的患者预后较差。在 PET/CT 后原发灶不明的患者中，进一步寻找无益。
