The role of positron emission tomography in occult primary head and neck cancers.
The role of positron emission tomography in occult primary head and neck cancers.
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发表时间：
1999-07
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通讯作者：
Safa Aa;Luu Tran;Sheila Rege;Brown Cv;Mandelkern Ma;Wang Mb;A. Sadeghi;Guy Juillard
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作者：
Safa Aa;Luu Tran;Sheila Rege;Brown Cv;Mandelkern Ma;Wang Mb;A. Sadeghi;Guy Juillard
目的评价正电子发射断层扫描(PET)氟脱氧葡萄糖(FDG)显像在不明原因的头颈部原发肿瘤中的应用价值。方法对14例原发灶来源不明(临床分期为N_2~N_3)的鳞状细胞癌患者进行前瞻性研究。患者接受了常规检查，包括体检、计算机断层扫描和潜在可疑部位的随机活组织检查。如果没有发现原发部位，则静脉注射8~13mCi的FDG，并获得具有标准化摄取值的全身扫描。将FDG-PET成像结果与临床、CT和组织病理学结果进行对照。为了消除偏见，之前对其他发现一无所知的核医学医生对PET扫描进行了审查。结果PET明确了3例原发肿瘤的位置：肺门、舌根、梨状窝。这些病变均经病理证实。除了梨状窝病变外，所有这些原发部位在CT或体检上均未显示，但最初的活检结果为阴性。在一名患者中，最初的PET没有发现原发肿瘤，但在放射治疗后的随访PET中发现了鼻咽癌。在其余9名患者中，从未发现原发病变。所有CT检出的颈淋巴结行正电子发射计算机断层扫描。讨论在我们的前瞻性研究中，约21%的患者可以通过FDG-PET发现以前未知的原发肿瘤。PET在指导内窥镜活检组织学诊断和治疗方案方面具有重要价值。
PURPOSE To evaluate the utility of positron emission tomography (PET) fluorodeoxyglucose (FDG) imaging in the workup of unknown primary head and neck tumors. METHODS Fourteen patients with squamous cell carcinoma of cervical lymph node metastasis of unknown primary origin (clinical stage N2-N3) were studied prospectively. The patients underwent conventional workup, including physical examination, computed tomography, and random biopsies of the potentially suspected sites. If no primary site was found, 8 to 13 mCi of FDG was given intravenously, and whole-body scans with standardized uptake values were obtained. The results of FDG-PET imaging were compared with clinical, CT, and histopathologic findings. To eliminate bias, PET scans were reviewed by nuclear medicine physicians who had no previous knowledge of the other findings. RESULTS PET identified the location of primary tumor in three patients: lung hilum, base of tongue, and pyriform sinus. These lesions were pathologically confirmed. All these primary sites were not visualized on CT or physical examination, except for a pyriform sinus lesion, which was seen on CT, but initial biopsy result was negative. In one patient, the initial PET did not identify a primary tumor, but a nasopharyngeal carcinoma was identified in post-radiation therapy follow-up PET. In the remaining nine patients, a primary lesion was never found. All cervical lymph nodes detected by CT were identified by PET. DISCUSSION A previously unknown primary tumor can be identified with FDG-PET in about 21% of the patients in our prospective series. PET can be of value in guiding endoscopic biopsies for histologic diagnosis and treatment options.