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The Diagnostic Contribution of (18)F-FDG PET/CT Scan in Cancer of Unknown Primary

Year 2018, Volume: 40 Issue: 3, 238 - 245, 30.09.2018

Serdar Savaş Gül

https://doi.org/10.7197/223.vi.412273

Abstract

OBJECTIVE: The
aim of the present study was to evaluate the clinically diagnostic contribution
of 18F-fluorodeoxyglucose positron emission tomography combined with
computed tomography(18F-FDG PET/CT) in patients with cancer
of unknown primary (CUP).



METHODS: The
retrospective investigation, cross-sectional analysis of 124 18F-FDG
PET/CT scans of patients with CUP between June 2014 and July 2015 was
performed. The increased 18F-FDG uptake focus were assessed in
correlation with histopathology. The diagnostic accuracy, sensitivity,
specificity, positive predictive value and negative predictive values were
assessed for 18F-FDG PET/CT.



RESULTS: The 18F-FDG PET/CT
successfully detected primary tumor in 56 patients with high 18F-FDG
uptake involvement (true positive, 45.2%). 58 patients whose final
histopathology and clinically without evidence of a primary tumor (true
negative, 46.8%). 8 patients whose final histopathologicallyand clinically without
evidence of a primary tumor but high 18F-FDG uptake involvement
(false positive, 6.4%). The 18F-FDG PET/CT scan results were
negative for primary site localization in only 2 patients with no 18F-FDG
uptake involvement (false negative, 1.6%). Generally, the diagnostic accuracy
was found to be 91.9%, sensitivity 96.5%, specificity 87.8%, positive
predictive value 87.5%, negative predictive value 96.6%, positive likelihood ratio
7.9% and negative likelihood ratio 0.04%.



CONCLUSION: It can be
said that 18F-FDG PET/CT may be useful in the diagnosis of patients
with CUP.

Keywords

cancer of unknown primary (18)F-FDG PET/CT sensitivity specificity

References

  • Fizazi K, Greco FA, Pavlidis N. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22 Suppl 6:vi64-68.
  • Elboga U, Kervancioğlu S, Sahin E, Basibuyuk M, Celen YZ, Aktolun C. Utility of F-18 fluorodeoxyglucose posıtron emıssıon tomography/computed ın carcınoma of unknown primary. Int J Clin Exp Pathol 2014;7(12):8941-6.
  • Pavlidis N, Fizazi K. Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol 2009;69:271-8.
  • Klein CA. Parallel progression of primary tumors and metastases. Nat Rev Cancer 2009;9:302-12.
  • Kwee TC, Basu S, Alavi A. PET and PET/CT for unknown primary tumors. Methods Mol Biol 2011;727:317-33.
  • Hasbek Z, Doğan ÖT, Sarı İ, Yücel B, Şeker MM, Turgut B, Berk S, Siliğ Y. The Diagnostic Value of the Correlation between Serum Anti-p53 Antibody and Positron Emission Tomography Parameters in Lung Cancer. Mol Imaging Radionucl Ther 2016;25(3):107-13.
  • Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol 2009;19(3):731-44.
  • Bochtler T, Löffler H, Kramer A. Diagnosis and management of metastatic neoplasms with unknown primary. Semin Diagn Pathol 2017. pii: S0740-2570(17)30147-8.
  • Riaz S, Nawaz MK, Faruqui ZS, Kazmi SA, Loya A, Bashir H. Diagnostic Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in the Evaluation of Carcinoma of Unknown Primary. Mol Imaging Radionucl Ther 2016;25(1):11-8.
  • Talavera-Rubio MP, Garcia-Vicente AM, Palomar-Munoz AM, Pilkington-Woll JP, Poblete-Garcia VM, Soriano-Castrejon A. Usefulness of (18) F-fluorodeoxyglucose-positron emission tomography computerized tomography in the identification of the primary tumor in patients with cancer of unknown origin. Med Clin (Barc) 2013;140:14-9.
  • Burglin SA, Hess S, Hoilund-Carlsen PF, Gerke O. 18F-FDG PET/CT for detection of the primary tumor in adults with extracervical metastases from cancer of unknown primary: A systematic review and meta-analysis. Medicine (Baltimore) 2017;96(16):e6713.
  • Börksüz MF, Erselcan T, Hasbek Z, Yücel B, Turgut B. Morphologic and Metabolic Comparison of Treatment Responsiveness with 18Fludeoxyglucose-Positron Emission Tomography/Computed Tomography According to Lung Cancer Type. Mol Imaging Radionucl Ther 2016;25(2):63-9.
  • Hasbek Z, Yucel B, Salk I, Turgut B, Erselcan T, Babacan NA, Kacan T. Potential impact of atelectasis and primary tumor glycolysis on F-18 FDG PET/CT on survival in lung cancer patients. Asian Pac J Cancer Prev 2014;15(9):4085-9.
  • Santhanam P, Chandramahanti S, Kroiss A, Yu R, Ruszniewski P, Kumar R, et al. Nuclear imaging of neuroendocrine tumors with unknown primary: why, when and how? Eur J Nucl Med Mol Imaging 2015;42(7):1144-55.
  • Özman Ö, Arslan N. The Role of PET/CT in Head and Neck Cancer. Turkiye Klinikleri J E.N.T.-Special Topics 2010;3(4):72-81.
  • Su YY, Chen SS, Hsieh CH, Liao CT, Lin CY, Kang CJ, et al. Defining risk groups of patients with cancer of unknown primary site and cervical nodal metastases by F-18 fluorodeoxyglucose positron emission tomography and computed tomography imaging. Kaohsiung J Med Sci 2016;32(8):407-13.
  • İnan İE, Kılıç C, Tunçel Ü. The correlation of positron emission tomography-computed tomography assessment with histopathological results in the diagnosis of head and neck cancer of unknown primary. Kulak Burun Bogaz Ihtis Derg 2012;22(6):319-23.
  • Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, Nam SY, et al. Utility of combined (18)F-fluorodeoxyglucose-positron emission tomography and computed tomography in patients with cervical metastases from unknown primary tumors. Oral Oncol 2009;45:218-24.
  • Nassenstein K, Veit-Haibach P, Stergar H, Gutzeit A, Freudenberg L, Kuehl H, et al. Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography. Acta Radiol 2007;48:1101-8.
  • Wang G, Wu Y, Zhang W, Li J, Wu P, Xie C. Clinical value of whole-body F-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with carcinoma of unknown primary. J Med Imaging Radiat Oncol 2013;57:65-71.
  • Algin E, Ozet A, Gumusay O, Cetin B, Akdemir UO, Benekli M, et al. Association between survival and maximum standardized uptake value of liver metastases detected by 18-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in patients with adenocarcinoma of unknown primary origin. Ann Nucl Med 2014;28(9):891-6.
  • Ouyang L, Shi ZY, Lin ZG. 18F-FDG PET-CT makes a significant contribution to diagnosis of malignancy in patients with cervical lymphadenopathy: a study using optimal scale regression tests. Chin Med J (Engl) 2013;126:659-67.
  • Chorost MI, Lee MC, Yeoh CB, Molina M, Ghosh BC. Unknown primary. J Surg Oncol 2004;87(4):191-203.
  • Regelink G, Brouwer J, de Bree R. Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities. Eur J Nucl Med Mol Imaging 2002;29(8):1024-30.
  • Stokkel MP, Bongers V, Hordijk GJ, van Rijk PP. FDG positron emission tomography in head and neck cancer: pitfall or pathology? Clin Nucl Med. 1999;24:950-4.
  • Çakır T, Atasever T. F-18 Flourodeoxy Glucose Positron Emission Tomography/ Computed Tomography Imaging in Infection and Inflammation. Nucl Med Semin 2016;2:79-89.
  • Nassenstein K, Veit-Haibach P, Stergar H, Gutzeit A, Freudenberg L, Kuehl H, et al. Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography. Acta Radiol 2007;48:1101-8.
  • Gutzeit A, Antoch G, Kühl H, Egelhof T, Fischer M, Hauth E, et al. Unknown primary tumors: detection with dual-modality PET/CT-initial experience. Radiology 2005;234:227-34.
  • Kaya AO, Coskun U, Unlu M, Akdemir UO, Ozdemir NY, Zengin N, et al. Whole body 18F-FDG PET/CT imaging in the detection of primary tumours in patients with a metastatic carcinoma of unknown origin. Asian Pac J Cancer Prev 2008;9:683-6.
  • Kole AC, Nieweg OE, Pruim J. Detection of unknown occult primary tumors using positron emission tomography. Cancer 1998;82:1160-6.

Primeri Bilinmeyen Kanserde F(18)-FDG PET/BT Tetkikinin Tanıya Katkısı

Year 2018, Volume: 40 Issue: 3, 238 - 245, 30.09.2018

Serdar Savaş Gül

https://doi.org/10.7197/223.vi.412273

Abstract

GİRİŞ:
Bu
çalışmanın amacı, primeri bilinmeyen kanser (PBK) hastalarında
18F-florodeoksiglukoz pozitron emisyon tomografisi/bilgisayarlı tomografinin
(F18-FDG PET/BT) klinik olarak tanıya katkısını değerlendirmektir.

YÖNTEM:
Retrospektif, kesitsel analiz çalışmasında Haziran 2014-Temmuz 2015 tarihleri
arasında 124 PBK hastalarının F18-FDG PET/BT incelemesi yapıldı. Artmış 18F-FDG
tutulum odağının histopatoloji ile korelasyonu değerlendirildi. F18-FDG PET/BT
için tanısal doğruluk, duyarlılık, özgüllük, pozitif öngörü değeri ve negatif
öngörü değerleri hesaplandı.

BULGULAR:
F18-FDG PET/BT, yüksek F18-FDG tutulumu olan 56 hastada primer tümör odağını
başarıyla saptadı (gerçek pozitif, % 45.2). 58 hastada histopatolojik ve klinik
olarak primer tümör bulunamadı (gerçek negatif, % 46.8). 8 hastada yüksek
F18-FDG uptake tutulumu olmasına karşın histopatolojik ve klinik olarak primer
tümör kanıtı yoktu (yanlış pozitif, % 6.4). Sadece 2 hastada negatif F18-FDG
PET/BT tarama sonuç bulunmasına karşın primer tümör histopatolojik olarak
saptandı (yanlış negatif, % 1.6) primer yerleşim lokalizasyonu için negatif
idi. Genel olarak tanısal doğruluk % 91.9, duyarlılık % 96.5, özgüllük % 87.8,
pozitif öngörü değeri % 87.5, negatif öngörü değeri % 96.6, pozitif olabilirlik
oranı % 7.9 ve negatif olabilirlik oranı % 0.04 olarak bulundu.







SONUÇ:
PBK hastalarının tanısında F18-FDG PET/BT’nin yararlı olabileceği
düşünülebilir.

Keywords

primeri bilinmeyen kanser F18-FDG PET/BT duyarlılık özgüllük

References

  • Fizazi K, Greco FA, Pavlidis N. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22 Suppl 6:vi64-68.
  • Elboga U, Kervancioğlu S, Sahin E, Basibuyuk M, Celen YZ, Aktolun C. Utility of F-18 fluorodeoxyglucose posıtron emıssıon tomography/computed ın carcınoma of unknown primary. Int J Clin Exp Pathol 2014;7(12):8941-6.
  • Pavlidis N, Fizazi K. Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol 2009;69:271-8.
  • Klein CA. Parallel progression of primary tumors and metastases. Nat Rev Cancer 2009;9:302-12.
  • Kwee TC, Basu S, Alavi A. PET and PET/CT for unknown primary tumors. Methods Mol Biol 2011;727:317-33.
  • Hasbek Z, Doğan ÖT, Sarı İ, Yücel B, Şeker MM, Turgut B, Berk S, Siliğ Y. The Diagnostic Value of the Correlation between Serum Anti-p53 Antibody and Positron Emission Tomography Parameters in Lung Cancer. Mol Imaging Radionucl Ther 2016;25(3):107-13.
  • Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol 2009;19(3):731-44.
  • Bochtler T, Löffler H, Kramer A. Diagnosis and management of metastatic neoplasms with unknown primary. Semin Diagn Pathol 2017. pii: S0740-2570(17)30147-8.
  • Riaz S, Nawaz MK, Faruqui ZS, Kazmi SA, Loya A, Bashir H. Diagnostic Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in the Evaluation of Carcinoma of Unknown Primary. Mol Imaging Radionucl Ther 2016;25(1):11-8.
  • Talavera-Rubio MP, Garcia-Vicente AM, Palomar-Munoz AM, Pilkington-Woll JP, Poblete-Garcia VM, Soriano-Castrejon A. Usefulness of (18) F-fluorodeoxyglucose-positron emission tomography computerized tomography in the identification of the primary tumor in patients with cancer of unknown origin. Med Clin (Barc) 2013;140:14-9.
  • Burglin SA, Hess S, Hoilund-Carlsen PF, Gerke O. 18F-FDG PET/CT for detection of the primary tumor in adults with extracervical metastases from cancer of unknown primary: A systematic review and meta-analysis. Medicine (Baltimore) 2017;96(16):e6713.
  • Börksüz MF, Erselcan T, Hasbek Z, Yücel B, Turgut B. Morphologic and Metabolic Comparison of Treatment Responsiveness with 18Fludeoxyglucose-Positron Emission Tomography/Computed Tomography According to Lung Cancer Type. Mol Imaging Radionucl Ther 2016;25(2):63-9.
  • Hasbek Z, Yucel B, Salk I, Turgut B, Erselcan T, Babacan NA, Kacan T. Potential impact of atelectasis and primary tumor glycolysis on F-18 FDG PET/CT on survival in lung cancer patients. Asian Pac J Cancer Prev 2014;15(9):4085-9.
  • Santhanam P, Chandramahanti S, Kroiss A, Yu R, Ruszniewski P, Kumar R, et al. Nuclear imaging of neuroendocrine tumors with unknown primary: why, when and how? Eur J Nucl Med Mol Imaging 2015;42(7):1144-55.
  • Özman Ö, Arslan N. The Role of PET/CT in Head and Neck Cancer. Turkiye Klinikleri J E.N.T.-Special Topics 2010;3(4):72-81.
  • Su YY, Chen SS, Hsieh CH, Liao CT, Lin CY, Kang CJ, et al. Defining risk groups of patients with cancer of unknown primary site and cervical nodal metastases by F-18 fluorodeoxyglucose positron emission tomography and computed tomography imaging. Kaohsiung J Med Sci 2016;32(8):407-13.
  • İnan İE, Kılıç C, Tunçel Ü. The correlation of positron emission tomography-computed tomography assessment with histopathological results in the diagnosis of head and neck cancer of unknown primary. Kulak Burun Bogaz Ihtis Derg 2012;22(6):319-23.
  • Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, Nam SY, et al. Utility of combined (18)F-fluorodeoxyglucose-positron emission tomography and computed tomography in patients with cervical metastases from unknown primary tumors. Oral Oncol 2009;45:218-24.
  • Nassenstein K, Veit-Haibach P, Stergar H, Gutzeit A, Freudenberg L, Kuehl H, et al. Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography. Acta Radiol 2007;48:1101-8.
  • Wang G, Wu Y, Zhang W, Li J, Wu P, Xie C. Clinical value of whole-body F-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with carcinoma of unknown primary. J Med Imaging Radiat Oncol 2013;57:65-71.
  • Algin E, Ozet A, Gumusay O, Cetin B, Akdemir UO, Benekli M, et al. Association between survival and maximum standardized uptake value of liver metastases detected by 18-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in patients with adenocarcinoma of unknown primary origin. Ann Nucl Med 2014;28(9):891-6.
  • Ouyang L, Shi ZY, Lin ZG. 18F-FDG PET-CT makes a significant contribution to diagnosis of malignancy in patients with cervical lymphadenopathy: a study using optimal scale regression tests. Chin Med J (Engl) 2013;126:659-67.
  • Chorost MI, Lee MC, Yeoh CB, Molina M, Ghosh BC. Unknown primary. J Surg Oncol 2004;87(4):191-203.
  • Regelink G, Brouwer J, de Bree R. Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities. Eur J Nucl Med Mol Imaging 2002;29(8):1024-30.
  • Stokkel MP, Bongers V, Hordijk GJ, van Rijk PP. FDG positron emission tomography in head and neck cancer: pitfall or pathology? Clin Nucl Med. 1999;24:950-4.
  • Çakır T, Atasever T. F-18 Flourodeoxy Glucose Positron Emission Tomography/ Computed Tomography Imaging in Infection and Inflammation. Nucl Med Semin 2016;2:79-89.
  • Nassenstein K, Veit-Haibach P, Stergar H, Gutzeit A, Freudenberg L, Kuehl H, et al. Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography. Acta Radiol 2007;48:1101-8.
  • Gutzeit A, Antoch G, Kühl H, Egelhof T, Fischer M, Hauth E, et al. Unknown primary tumors: detection with dual-modality PET/CT-initial experience. Radiology 2005;234:227-34.
  • Kaya AO, Coskun U, Unlu M, Akdemir UO, Ozdemir NY, Zengin N, et al. Whole body 18F-FDG PET/CT imaging in the detection of primary tumours in patients with a metastatic carcinoma of unknown origin. Asian Pac J Cancer Prev 2008;9:683-6.
  • Kole AC, Nieweg OE, Pruim J. Detection of unknown occult primary tumors using positron emission tomography. Cancer 1998;82:1160-6.
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Medical Science Research Articles
Authors

Serdar Savaş Gül 0000-0003-4822-2588

Publication Date September 30, 2018
Acceptance Date July 31, 2018
Published in Issue Year 2018Volume: 40 Issue: 3

Cite

AMA Gül SS. The Diagnostic Contribution of (18)F-FDG PET/CT Scan in Cancer of Unknown Primary. CMJ. September 2018;40(3):238-245. doi:10.7197/223.vi.412273