The Value of Whole Body 18f-Fdg PET/CT Imaging in Cytologically Proven Metastatic Cervical Carcinoma of Unknown Primary (Ccup):a Retrospective Study

摘要

Background
　　Carcinoma of unknown primary (CUP) represents a heterogeneous group of metastatic malignancies for which no primary tumor site can be identified after extensive routine diagnostic workup. Failure at this level has led to patients being referred for a whole body 18F-FDG PET/CT scan in attempt to localize the primary site.
　　Purpose
　　The aim of this study was to assess the potential of 1?F-fluorodeoxyglucose (1?FDG) whole body positron emission tomography/computed tomography (PET/CT) imaging, in patients referred with metastatic cervical carcinomas of unknown primaries (CCUP), in detecting the primary tumor and concomitant metastases as well as to investigate the presence of any prognostic factors to this heterogeneous group of tumors.
　　Materials and methods
　　Eighty consecutive patients with cervical metastasis of CUP (CCUP) who had previously undergone PET/CT between January 2010 and September 2012 were retrospectively analyzed. All patients had histologically proven cervical metastatic carcinomas and relevant diagnostic workup prior to 18F-FDG PET/CT failed to detect a primary tumor. All the patients included have full follow-up material. The average time of follow-up was of 16 months, ranging from 4 to 34 months. The golden standard used was the final clinical diagnosis.
　　Results
　　Whole body 18F-FDG PET/CT scan correctly detected the primary tumor in 55％(44 of 80) of patients with histologically proven cervical CUP. The sensitivity, specificity, and accuracy of 18F-FDG PET/CT scans were 91.6%, 90.6%, and 91.25%, respectively. The lung and head/neck area were the two most commonly detected primary tumor sites (36%each). The positive predictive value was 93.6%and negative predictive value was 87.8%.
　　Furthermore, in 25%(20 out of 80) of patients, 18F-FDG PET/CT detected extra-nodal distant metastases (M stage) leading to a re-staging and possibly influencing subsequent treatment plans.Cox hazard ratio regression analysis revealed a significant difference in overall survival between patients presenting with extra-nodal metastases (M stage), with a hazard ratio of 5.22 at 95%CI (1.820-11.433, P=0.001) higher than those without distant metastasis. There were no statistically significant associations between other factors and prognosis.
　　Conclusion
　　The present study indicates that whole body 18F-FDG PET/CT scan is a significant and valuable tool in the identification of the primary tumor site in patients with CCUP. Furthermore, FDG PET/CT scans are of great value in the assessment of the extent of nodal involvement and in detecting the presence of extra-nodal metastases, further optimizing the management of these patients.

目录

封面

声明

目录

Abbreviations

英文摘要

PART I The value of whole body 18F-FDG PET/CT imaging in cytologically proven metastatic cervical carcinoma of unknown primary \(CCUP\):a retrospective study

1. Introduction

2. Materials and methods

3. Results

4. Discussion:

5. Conclusions

参考文献

Part II Development in the diagnosis of Carcinoma of Unknown Primary:Review of the literature.

Introduction

Clinical behavior of CUP

Diagnosis and staging

Conclusion

致谢