Abstract
BackgroundThis study aimed to determine the ability of multimodal evaluation with multiparametric 3T-MRI (MPMRI) and positron emission tomography - computed tomography (PET/CT) to detect cancer of unknown primary origin (CUP) with neck lymph node (LN) metastasis.MethodsThe study group comprised 38 retrospectively analysed consecutive patients with LN metastasis in the head and neck (HN) region without known primary tumours (PTs). Statistical values of 3T-MRI and of FDG-PET/CT scans were evaluated.ResultsOf the 38 CUPs, conventional native T1-, T2-weighted and STIR sequences detected 6 PTs. Native sequences plus diffusion-weighted imaging (DWI) found 14-, and with fat suppression contrast-enhanced T1-weighted measurement as well as with the complex MPMRI found 15 primaries and with PET/CT 17 CUPs could be evaluated, respectively. The detection rates were 15.8, 36.8, 39.5, 39.5 and 44.7 % for conventional native MRI, native plus DWI, native with contrast-enhanced MRI (CE-MRI), for MPMRI, and for PET/CT, respectively. The overall detection rate proved by histology was 47.4 %. PET/CT provided the highest sensitivity (Sv: 94.4 %) but a lower specificity (Sp: 65.0 %), using MPMRI (Sv: 88.2 %) the specificity increased to 71.4 %. DWIincreased specificity of the native sequences (Sp: 76.2 %). Conventional native sequences plus DWI as well as 3T-MPMRI and PET/CT were same accurate (Acc: 79.0 %) and had similar likelihood ratio (LR: 3.42, 3.03 and 2.62) in detecting unknown PT sites.ConclusionsThe accuracy of FDG-PET/CT and MPMRI in case of CUP in finding the primary cancer in the neck regions is identical. While using PET/CT whole body information can be obtained in one examination. MPMRI shows the local soft tissue status more accurately. In cases of CUP PET/CT should be the first method of choice if it is available. MPMRI can clarify the exact primary tumor stage, and it can be advantageous in clarifying the prognostic factors, which is necessary in case of advanced tumor stage and when surgery is under consideration. In case low N stage is likely after the clinical examination and wait and see policy can be considered, MPMRI is recommended, and in this case the significance the of radiation free MPMRI is increasing.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0097-x) contains supplementary material, which is available to authorized users.
Highlights
This study aimed to determine the ability of multimodal evaluation with multiparametric 3T-magnetic resonance imaging (MRI) (MPMRI) and positron emission tomography - computed tomography (PET/CT) to detect cancer of unknown primary origin (CUP) with neck lymph node (LN) metastasis
We retrospectively reviewed the medical records of all patients with a diagnosis of neck LN metastasis of CUP, who underwent 3T multiparametric 3T-MRI (MPMRI) with conventional as well as diffusion-weighted imaging (DWI) and whole-body fluoro-2-deoxy-D-glucose (FDG)PET/CT examinations between July 01, 2012 and May 15, 2016
All patients had carcinoma proven by cytology after FNAB from a cervical LN metastasis before PET/CT and MRI
Summary
This study aimed to determine the ability of multimodal evaluation with multiparametric 3T-MRI (MPMRI) and positron emission tomography - computed tomography (PET/CT) to detect cancer of unknown primary origin (CUP) with neck lymph node (LN) metastasis. According to the European Society for Medical Oncology (ESMO) guidelines, cancers of unknown primary origin (CUP) represent a heterogeneous group of metastatic tumours for which a standardised diagnostic work-up fails to identify the site of origin at the time of diagnosis. CUPs account for 3–5 % of all malignancies [3, 4] and in 24–36 % of patients with CUPs, the metastatic lymph node (LN) manifestations of the unknown primary cancer are in the head and neck (HN) region [5]. In cases of CUP in the HN, the outcome is more favourable, with 5-year survival ranging from 35 to 50 %; this is especially true in cases with detected PTs because targeted therapy is possible (PT surgery, radiation focused to the tumour) [7]
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