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Matsuoka M, Onodera T, Yokota I, Iwasaki K, Suzuki Y, Masanari H, Kondo E, Iwasaki N. Bone metastatic cancer of unknown primary at initial presentation. Clin Transl Oncol 2024; 26:461-467. [PMID: 37395989 DOI: 10.1007/s12094-023-03267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Cancer of unknown primary (CUP) is a challenging malignancy. The purpose of this study was to investigate the clinical characteristics and prognosis of bone metastatic CUP using the population-based Surveillance, Epidemiology, and End Results (SEER) database. METHODS From the SEER database, we identified 1908 patients with bone metastatic CUP at initial presentation between 2010 and 2018. Histology was subdivided following International Classification of Diseases for Oncology codes as Adenocarcinoma, Squamous cell, Neuroendocrine, or Carcinoma not otherwise specified (NOS). Cox proportional hazard modeling was applied using factors of age, sex, ethnicity, histological subtype, and therapeutic intervention. RESULTS Among the 1908 patients, histology was Neuroendocrine in 240 patients, Squamous cell in 201 patients, Adenocarcinoma in 810 patients and NOS in 657 patients. In each subtype, patients tended to be predominantly male and white. Chemotherapy was introduced for 28% of patients and radiation for 34% in the entire cohort. Survival in patients with bone metastatic CUP was unfavorable, with a median survival of 2 months. Among the histological subtypes, Adenocarcinoma showed shorter survival than the other groups. In addition, treatment interventions such as chemotherapy and radiation therapy prolonged survival, particularly for Squamous cell, Adenocarcinoma and NOS, but not for Neuroendocrine. DISCUSSION Bone metastatic CUP showed extremely poor prognosis, but treatment interventions such as chemotherapy and radiation generally offered survival benefits. Further randomized clinical research is needed to confirm the present results.
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Affiliation(s)
- Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Kita-15, Nish-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hamasaki Masanari
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, North 14 West 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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Nissan E, Amit U, Baron L, Zabatani A, Urban D, Barshack I, Davidson T. The usefulness of [18F]FDG-PET/CT in detecting and managing cancers with unknown primary site depends on histological subtype. Sci Rep 2021; 11:17732. [PMID: 34489490 PMCID: PMC8421436 DOI: 10.1038/s41598-021-96451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/05/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed the role of [18F]FDG-PET/CT in identifying and managing cancer of unknown primary site (CUP syndrome). We reviewed [18F]FDG-PET/CT scans of individuals with CUP syndrome recorded in clinical referral letters from 2012 to 2019. We evaluated the identification of primary tumor (PT) by [18F]FDG-PET/CT, according to histological subtype, and the impact on clinical management. The median age was 65 years, 36/64 males (56%). PTs were detected in 28/64 (44%) patients. Detection was significantly lower in patients with squamous cell carcinoma (SCC) than with other histologies combined, p = 0.034. Mean age, mean SUVmax (10.6 ± 6.0) and organ involvement were similar between patients with and without discovered PTs; and between patients with SCC and with other histologies combined. However, those with SCC were less likely than the others to present with multi-lesion involvement, p < 0.001. [18F]FDG-PET/CT interpretations apparently affected treatment of 8/28 (29%) patients with PT detected, and in none of the 35 whose PT was not discovered, p < 0.001. [18F]FDG-PET/CT appeared helpful in detecting PT in almost half the patients with CUP syndrome; the lowest rate was for patients with SCC pathology. PET/CT showed limited overall value in guiding clinical management, however benefited those with discovered PT.
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Affiliation(s)
- Ella Nissan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amit
- Radiation Oncology Department, Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Leo Baron
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Zabatani
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Damien Urban
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Barshack
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Soni N, Ora M, Aher PY, Mishra P, Maheshwarappa RP, Priya S, Graham MM. Role of FDG PET/CT for detection of primary tumor in patients with extracervical metastases from carcinoma of unknown primary. Clin Imaging 2021; 78:262-270. [PMID: 34174653 DOI: 10.1016/j.clinimag.2021.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore the diagnostic performance of 18F-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). MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Neetu Soni
- Nuclear Medicine Resident at University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52246, USA.
| | - Manish Ora
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Pritish Y Aher
- Fellow Chest Imaging, Radiology Department, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52246, USA
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Sarv Priya
- Resident Radiology Department, UIHC, Iowa city 52246, IA, USA.
| | - Michael M Graham
- Radiology - Division of Nuclear Medicine, Radiation Oncology, 3863 JPP, Iowa City, IA 52242, USA.
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Lung Adenocarcinoma Presenting as a Soft Tissue Metastasis to the Shoulder: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57020181. [PMID: 33672554 PMCID: PMC7923794 DOI: 10.3390/medicina57020181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
Background: Metastasis to soft tissue is rare, and the pathogenesis remains unclear. Soft tissue metastases (STMs) have varied presentations; existing reports are few. Herein, we report a case of STMs of the shoulder with a rich characterization. Case presentation: A 93-year-old man presented to our hospital with pain and swelling of the left shoulder for one week. Magnetic resonance imaging (MRI) showed a T1 low-intensity and T2 high-intensity mass. We suspected a primary sarcoma and performed a needle biopsy. However, on histopathological examination, the findings were suggestive of lung adenocarcinoma. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography also revealed FDG accumulation in the right lung, thus confirming the diagnosis. Conclusion: Oncologists should keep in mind that STMs of lung cancer may resemble soft-tissue sarcomas at the time of initial diagnosis.
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Zytoon AA, Elsayed EE, Nassar AI, Murakami K. Pivotal role of PET/CT in characterization of occult metastasis with undetermined origin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this multicenter diagnostic accuracy test study was conducted to assess the role of positron emission tomography/computed tomography in the detection of primary tumor in cases of metastasis of undetermined primary site, to estimate its capability in detecting additional lesions as well as evaluating disease burden and staging. This multicentric diagnostic accuracy test study included 175 patients with pathologically proven, radiologically, and/or clinically suspected metastatic lesions of undetermined primary site. Clinical, surgical, and histopathologic findings and correlative imaging modalities were used to assess the results of PET/CT; the accuracy of PET/CT was expressed in terms of sensitivity and specificity, positive and negative predictive values.
Results
The study included 175 patients; PET-CT-positive lesions suggestive of primary malignant tumors were detected in 105 out of 175 patients. These lesions were pathologically proven to be malignant (true positive) in 100/175 patients (57.1%). Five out of 175 patients (2.9%) proved to be falsely positive after pathologic assessment; 70 out of 175 patients (40%) were negative for detection of primary malignancy all over the body by PET/CT (true negative) with no false negative results. PET/CT achieved a sensitivity of 100%, and specificity of 93.3% in detection of unknown primary tumor location.
Conclusion
PET/CT is an effective modality for early detection of the primary tumor site in patients with cancer of undetermined primary (CUP) which facilitates early selection of appropriate treatment protocols that will improve patients’ prognosis.
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6
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Cystic form of cervical lymphadenopathy in adults. Guidelines of the French Society of Otorhinolaryngology (short version). Part 2–etiological diagnosis procedure: Clinical and imaging assessment. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:117-121. [DOI: 10.1016/j.anorl.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Lin YY, Cho SF. Occult scar carcinoma of the lung with overt liver metastases and high serum CA 19-9 levels. J Postgrad Med 2019; 65:251-252. [PMID: 31611432 PMCID: PMC6813679 DOI: 10.4103/jpgm.jpgm_145_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Y Y Lin
- Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - S F Cho
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Thapa P, Kalshetty A, Basu S. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in carcinoma of unknown primary: A subgroup-specific analysis based on clinical presentation. World J Nucl Med 2018; 17:219-222. [PMID: 30505217 PMCID: PMC6216728 DOI: 10.4103/wjnm.wjnm_62_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to explore the clinical efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in tumor detection in patients with proven or suspected carcinoma of unknown primary origin (CUP) and making a subgroup-specific analysis. This was a retrospective, cross-sectional survey of patients with CUP syndrome who were referred for 18F-FDG PET-CT studies over a 2-year period. FDG-PET-CT scans were performed in compliance with the standard whole-body protocol, i.e., at least 6 h of fasting and were carried out with injected FDG radioactivity dose between 259 MBq and 370 MBq. The time from FDG injection to PET data acquisition was between 60 and 90 min. PET/CT scanning was acquired from the skull base to the upper third of the thighs. Nonenhanced, low-dose attenuation correction CT (110/70 kV/mAs) was performed for all patients. Twenty-one patients of clinically designated with CUP (male:female = 7:14; age range: 42–70 years; mean age: 57.95 years) fulfilling the inclusion criteria were enrolled in this analysis. The patients were subdivided into two groups: A - Those with histopathological proof (n = 12); B - Those with clinical/tumor markers/radiological suspicion of malignancy (n = 9). Among the first group, the sites of metastases in decreasing order of frequency were lymph nodes (n = 9/20; 75%), brain (n = 2; 16.67%), and liver (n = 1; 8.33%). In group B, six patients (66.7%) presented with hypodense/enhancing lesions in the brain and three (33.3%) had altered marrow signal intensity of spine. Overall, hypermetabolic lesions on FDG-PET/CT indicating the primary tumor sites were identified in 14 patients (66.7%). Twelve out of 14 primary sites were subsequently proven by histopathology, whereas two patients with biopsy-proven metastatic lesions in brain, with suspicious primary site in lung had been corroborated by FDG-PET/CT revealing multiple other metastatic sites, were not biopsied and were subsequently enrolled for palliative chemotherapy. When the results were examined individually in each of the Group A and Group B, the primary tumor detection rate was 58.3% and 77.7%, respectively. The identified primary tumor sites were lung 9/14 (64.4%), uterus/cervi 2/14 (14.3%), breast 1/14 (7.1%), esophagus 1/14 (7.1%), and aryepiglottic fold 1/14 (7.1%). In conclusion, FDG-PET/CT is not only helpful in histologically proven cases of CUP (irrespective of the metastatic sites), this modality also demonstrates high tumor detection rate in patients with clinical/radiological suspicion of malignancy. Being a whole body technique, it can additionally aid in disease staging in these patients which could be potentially helpful in their clinical management.
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Affiliation(s)
- Pradeep Thapa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Kalshetty
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Cengiz A, Göksel S, Yürekli Y. Diagnostic Value of 18F-FDG PET/CT in Patients with Carcinoma of Unknown Primary. Mol Imaging Radionucl Ther 2018; 27:126-132. [PMID: 30317849 PMCID: PMC6191738 DOI: 10.4274/mirt.64426] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The aim of this study is to investigate the clinical role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with carcinoma of unknown primary (CUP). Methods: One hundred twenty one patients with a diagnosis of CUP who underwent whole body 18F-FDG PET/CT imaging were included in this retrospective study. The final diagnoses were confirmed either histopathologically or by clinical follow-up. Results: The 18F-FDG-PET/CT successfully detected the primary tumor in 59 out of 121 (49%) patients. The most common primary tumor as detected by 18F-FDG PET/CT was lung cancer (n=31). In a patient, two primary tumors (colon and prostate) were detected on PET/CT imaging. Bone marrow biopsy revealed prostate cancer in this patient and the colon cancer was accepted as a synchronous second primary tumor. 18F-FDG PET/CT findings were false-positive in 11 patients. 18F-FDG PET/CT could not detect any primary lesion in 51 patients, whose conventional work-up detected a primary tumor in 11 and thus considered as false-negative. The sensitivity, specificity rate and accuracy of 18F-FDG PET/CT in detection of primary tumor were identified as 84%, 78% and 82%, respectively. Conclusion: Whole body 18F-FDG PET/CT is an effective method for detecting the primary tumor in patients with CUP. In addition to detecting the primary tumor, it can also help determine disease extent and contribute to patient management.
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Affiliation(s)
- Arzu Cengiz
- Adnan Menderes University Faculty of Medicine, Department of Nuclear Medicine, Aydın, Turkey
| | - Sibel Göksel
- Adnan Menderes University Faculty of Medicine, Department of Nuclear Medicine, Aydın, Turkey
| | - Yakup Yürekli
- Adnan Menderes University Faculty of Medicine, Department of Nuclear Medicine, Aydın, Turkey
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Dere Y, Ekmekçi S, Çelik S, Çelik Öİ, Dere Ö, Karakuş V. Where do these guests come from? A diagnostic approach for metastatic lymph nodes. Turk J Surg 2018; 34:131-136. [PMID: 30023978 DOI: 10.5152/turkjsurg.2018.3856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/12/2017] [Indexed: 11/22/2022]
Abstract
Objective In cases presenting with lymphadenopathies (LAP) without a primary focus detected by simple radiological methods, the primary tumor can be diagnosed by a histopathological evaluation of the metastatic lymph nodes. We aimed to discuss the nonhematological malignancies presenting with lymphadenopathies and the histopathological results for primary tumors. Material and Methods In this retrospective study, cases diagnosed with metastasis in excisional lymph nodes between January 2013 and June 2016 were assessed for a histopathological diagnostic approach. Results Among 632 lymph node biopsies, a total of 21 cases, involving 12 male and 9 female patients with a mean age of 57.23 y (range, 33-92 y), of nonhematological solid tumors were included. The most common localizations of the involved lymph nodes were inguinal (n=8), axillary (n=6), cervical (n=4), and supraclavicular (n=3) region. The most common primary tumors were malignant melanoma (n=6), breast carcinoma (n=4), ovarian carcinoma (n=2), squamous cell carcinoma (n=2), and germ cell tumor (n=2). Others were papillary thyroid carcinoma, renal cell carcinoma, urothelial carcinoma, prostate adenocarcinoma, and endometrial adenocarcinoma. Conclusion Nonhematological malignancies presenting with lymphadenopathies are one of the most complicated cases for clinicians. The histopathological evaluation of the excisional metastatic lymph node biopsies is an important method because of cost effectiveness and easy applicability.
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Affiliation(s)
- Yelda Dere
- Department of Pathology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Sümeyye Ekmekçi
- Department of Pathology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Serkan Çelik
- Department of Pathology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Özgür İlhan Çelik
- Department of Pathology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Özcan Dere
- Department of General Surgery, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Volkan Karakuş
- Department of Hematology, Muğla Sıtkı Koçman Training and Research Hospital, Muğla, Turkey
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Cancer of unknown primary origin: Can FDG PET/CT have a role in detecting the site of primary? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Müller von der Grün J, Tahtali A, Ghanaati S, Rödel C, Balermpas P. Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site - current status and challenges. Radiat Oncol 2017; 12:82. [PMID: 28486947 PMCID: PMC5424363 DOI: 10.1186/s13014-017-0817-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose This review aims to provide a comprehensive overview of the literature and elucidate open questions for future clinical trials concerning diagnostics and treatment modalities for cervical cancer of unknown primary (CUP). Methods A literature search for head and neck CUP was performed with focus on diagnostics and therapies as well as molecular markers. Results High level evidence on CUP is limited. However, it seems that a consensus exists regarding the optimal diagnostic procedures. The correct implementation of biomarkers for patient stratification and treatment remains unclear. An even greater dispute dominates about the ideal treatment with publications ranging from sole surgery to surgery with postoperative bilateral radiotherapy with inclusion of the mucosa and concomitant chemotherapy. Conclusions Cervical CUP represents a very heterogeneous malignant disease. On this account many aspects concerning treatment optimization remain unclear, despite a considerable number of publications in the past. Future research in form of prospective randomized trials is needed in order to better define patient stratification criteria and enable tailored treatment.
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Affiliation(s)
- Jens Müller von der Grün
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Aykut Tahtali
- Department of Otolaryngology and Head and Neck Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Shahram Ghanaati
- Department of Maxillofacial Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Frankfurt, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany. .,German Cancer Consortium (DKTK), Frankfurt, Germany.
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Abstract
BACKGROUND To compare the diagnostic accuracy of PET/MR and PET/CT in patients with suspected occult primary tumors. METHODS This prospective study was approved by the institutional review board. Sequential PET/CT-MR was performed in 43 patients (22 male subjects; median age, 58 years; range, 20-86 years) referred for suspected occult primary tumors. Patients were assessed with PET/CT and PET/MR for the presence of a primary tumor, lymph node metastases, and distant metastases. Wilcoxon signed-rank test was performed to compare the diagnostic accuracy of PET/CT and PET/MR. RESULT According to the standard of reference, a primary lesion was found in 14 patients. In 16 patients, the primary lesion remained occult. In the remaining 13 patients, lesions proved to be benign. PET/MR was superior to PET/CT for primary tumor detection (sensitivity/specificity, 0.85/0.97 vs 0.69/0.73; P = 0.020) and comparable to PET/CT for the detection of lymph node metastases (sensitivity/specificity, 0.93/1.00 vs 0.93/0.93; P = 0.157) and distant metastases (sensitivity/specificity, 1.00/0.97 vs 0.82/1.00; P = 0.564). PET/CT tended to misclassify physiologic FDG uptake as malignancy compared with PET/MR (8 patients vs 1 patient). CONCLUSIONS PET/MR outperforms PET/CT in the workup of suspected occult malignancies. PET/MR may replace PET/CT to improve clinical workflow.
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Gődény M, Lengyel Z, Polony G, Nagy ZT, Léránt G, Zámbó O, Remenár É, Tamás L, Kásler M. Impact of 3T multiparametric MRI and FDG-PET-CT in the evaluation of occult primary cancer with cervical node metastasis. Cancer Imaging 2016; 16:38. [PMID: 27814768 PMCID: PMC5096285 DOI: 10.1186/s40644-016-0097-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023] Open
Abstract
Background 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. Methods The 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. Results Of 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. Conclusions The 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 material The online version of this article (doi:10.1186/s40644-016-0097-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mária Gődény
- Department of Diagnostic Radiology, National Institute of Oncology, Ráth György street 7-9, Budapest, 1122, Hungary. .,Department of Postgraduate Education and Scientific Research, University of Medicine and Pharmacy, Tirgu Mures, Romania.
| | - Zsolt Lengyel
- Pozitron Diagnostics LTD, Hunyadi János street 9, Budapest, 1117, Hungary
| | - Gábor Polony
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony u.36, Budapest, 1083, Hungary
| | - Zoltán Takácsi Nagy
- Department of Radiotherapy, National Institute of Oncology, Ráth György street 7-9, Budapest, 1122, Hungary
| | - Gergely Léránt
- Department of Diagnostic Radiology, National Institute of Oncology, Ráth György street 7-9, Budapest, 1122, Hungary
| | - Orsolya Zámbó
- Head and Neck Surgery Department, National Institute of Oncology, Ráth György street 7-9, Budapest, 1122, Hungary
| | - Éva Remenár
- Head and Neck Surgery Department, National Institute of Oncology, Ráth György street 7-9, Budapest, 1122, Hungary
| | - László Tamás
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony u.36, Budapest, 1083, Hungary
| | - Miklós Kásler
- Head and Neck Surgery Department, National Institute of Oncology, Ráth György street 7-9, Budapest, 1122, Hungary.,Department of Postgraduate Education and Scientific Research, University of Medicine and Pharmacy, Tirgu Mures, Romania
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15
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Testicular Signet-Ring Cell Metastasis from a Carcinoma of Unknown Primary Site: A Case Report and Literature Review. Case Rep Oncol Med 2016; 2016:7010173. [PMID: 27504206 PMCID: PMC4967671 DOI: 10.1155/2016/7010173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/05/2016] [Indexed: 11/29/2022] Open
Abstract
Signet-ring cell carcinoma is a highly malignant adenocarcinoma consisting of cells characterized as cytoplasmic vacuoles filled with mucin. The most common primary location of this type of cancer is the stomach, but it may also be found in other organs such as prostate, testis, bladder, ovaries, or colon. To date, metastatic signet-ring cell carcinoma of unknown primary (CUP) site to the testis is an extremely rare entity in daily practice. Reviewing the literature, we have been able to detect only three cases of testicular metastases from CUP, two with histological diagnosis of a signet-ring cell carcinoma and one with an adenocarcinoma. In this short paper, we report a case of a 56-year-old man who presented to our Department with testicular mass and ascites. Following a standard diagnostic approach no primary tumor could be identified. CUP was the final clinical diagnosis, histologically characterized as poorly differentiated adenocarcinoma with signet-ring cells involving the peritoneum and the testicular structures.
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16
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18F-FDG positron emission tomography in oncology: main indications. RADIOLOGIA 2016; 58:303-19. [PMID: 27184919 DOI: 10.1016/j.rx.2016.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/28/2016] [Indexed: 12/31/2022]
Abstract
The development of molecular and functional imaging with new imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography (PET) among others, has greatly improved the detection of tumors, tumor staging, and the detection of possible recurrences. Furthermore, the combination of these different imaging modalities and the continual development of radiotracers for PET have advanced our understanding and knowledge of the different pathophysiological processes in cancer, thereby helping to make treatment more efficacious, improving patients' quality of life, and increasing survival. PET is one of the imaging techniques that has attracted the most interest in recent years for its diagnostic capabilities. Its ability to anatomically locate pathologic foci of metabolic activity has revolutionized the detection and staging of many tumors, exponentially broadening its potential indications not only in oncology but also in other fields such as cardiology, neurology, and inflammatory and infectious diseases.
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17
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Tamam C, Tamam M, Mulazimoglu M. The Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Bone Lesions of Undetermined Origin. World J Nucl Med 2016; 15:124-9. [PMID: 27134563 PMCID: PMC4809153 DOI: 10.4103/1450-1147.176885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.
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Affiliation(s)
- Cuneyt Tamam
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
| | - Muge Tamam
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mulazimoglu
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
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18
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Nakamura E, Oda T, Yasunaga H, Aoyagi S. A Case of Femoral Arterial Bleeding by an Unknown Origin Metastatic Groin Lymph Nodes Carcinoma. Ann Vasc Dis 2016; 9:62-5. [PMID: 27087877 DOI: 10.3400/avd.cr.15-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/14/2015] [Indexed: 11/13/2022] Open
Abstract
We report a case of femoral arterial bleeding complicated with hemorrhagic shock caused by bacterial infection attributed to an inguinal lymph node metastasis of carcinoma of unknown primary. Because of severe preoperative condition, a venous patch plasty of ruptured artery, and omentopexy for the groin was performed as a less invasive surgery. But the recurrence of bleeding was occurred postoperatively. A staged operation, hemostasis with a venous patch plasty at a first stage, and an extra-anatomical bypass soon after improvement of shock condition in a second stage, can be one of surgical procedures to save the lives and salvage limbs.
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Affiliation(s)
- Eiji Nakamura
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Takeshi Oda
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Hiroshi Yasunaga
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Shigeaki Aoyagi
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
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19
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YAYLALI O, KIRAÇ FS, YÜKSEL D. The role of 18F-FDG PET-CT in the detection of unknown primary malignancy: a retrospective study. Turk J Med Sci 2016; 46:474-82. [DOI: 10.3906/sag-1502-99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/01/2015] [Indexed: 11/03/2022] Open
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20
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Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v133-8. [PMID: 26314775 DOI: 10.1093/annonc/mdv305] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - F A Greco
- Tennessee Oncology, Centennial Medical Center, Nashville, USA
| | - N Pavlidis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - G Daugaard
- Department of Oncology 5073, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K Oien
- University of Glasgow, Institute of Cancer Sciences, Glasgow, UK
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
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21
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Majchrzak E, Cholewiński W, Golusiński W. Carcinoma of unknown primary in the head and neck: The evaluation of the effectiveness of (18)F-FDG-PET/CT, own experience. Rep Pract Oncol Radiother 2015; 20:393-7. [PMID: 26549998 DOI: 10.1016/j.rpor.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/10/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of the present study was to estimate the clinical effectiveness of (18)F-FDG-PET/CT in the detection of the primary tumor in patients with histologically proven squamous cell carcinoma cervical lymph nodes metastasis from an unknown primary. BACKGROUND (18)F-fluorodeoxyglucose positron emission tomography combined with CT ((18)F-FDG-PET/CT) is believed to be very helpful in localization of primary tumor in CUP Syndrome patients. MATERIAL AND METHOD 41 patients referred to Poznan Medical University Department of Head and Neck Surgery from January 2010 to December 2013 with CUP Syndrome were included in the study. All patients presented fine-needle biopsy proven squamous cell carcinoma metastasis of the upper-, or mid neck lymph nodes. The final results were obtained from the histopathologic reports of tissue samples from anatomical regions suspected for primary tumor, additional imaging exams as well as clinical follow-up data. RESULTS The (18)F-FDG-PET/CT successfully detected primary tumor in 7 out of 41 patients (17%). In two more cases the primary tumor was indicated in the lung. 24 of 41 patients (58.5%) analyzed in our study remained without evidence of a primary tumor. In 4 cases (9.75%) we did not reveal any pathology within the localizations indicated by PET/CT on panendoscopy. In 4 cases we obtained histological confirmation of neoplasm on panendoscopy despite the negative results of PET/CT examinations. CONCLUSION We may suppose a relatively high usefulness of (18)F-FDG-PET/CT in the diagnosis process of CUP Syndrome patients. High NPV may indicate patients with no symptoms of primary tumor, which allows to avoid extensive resection or extra imaging.
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Affiliation(s)
- Ewa Majchrzak
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poland
| | - Witold Cholewiński
- Nuclear Medicine Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poland
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22
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Bara A, Pluta P, Jeziorski A. Diagnostic Imaging Efficacy In Metastases From Unknown Primary Site--Own Material. POLISH JOURNAL OF SURGERY 2015; 87:245-51. [PMID: 26172164 DOI: 10.1515/pjs-2015-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Indexed: 11/15/2022]
Abstract
UNLABELLED Cancer of Unknown Primary Origin (CUPO) is defined by the presence of metastatic lesions, diagnosed by means of cytological or pathological evaluation, for which no primary site can be detected during a thorough examination. The clinical investigation, directed at locating the site of the neoplastic lesion, is determined by the results of laboratory tests, imaging procedures, and pathological examinations. It is also essential to conduct a complete medical history and thorough physical examination. The detection of the primary site allowed to introduce specific therapy, which can offer clinical benefits, considering a favorable prognosis. The aim of the study was to assess the range of diagnostic procedures performed in patients with CUPO and efficacy in identifying the primary lesion. MATERIAL AND METHODS Retrospective analysis comprised a group of 29 patients with CUPO, operated between January, 2002 and December, 2011, at the Department of Surgical Oncology, Medical University in Łódź. The study group comprised 16 male and 13 female patients; median age at presentation was 58.3 years (ranging between 30-79 years). RESULTS Detailed diagnostic management depending on the location of metastatic lesions and their histological type was performed in 20 of the 29 study patients (69%). Considering the remaining 9 (31%) patients detailed diagnostics was not performed, due to the patients' poor general condition. In 55% (11/20) of patients subject to detailed diagnostics, the primary neoplastic lesion was determined. CONCLUSIONS Considering the study group, most patients with cancer of unknown primary origin were characterized by a favorable prognosis, which justified thorough diagnostics, in order to establish the primary neoplastic lesion. The introduction of diagnostic examinations enabled to identify the primary site of the tumor in more than 50% of patients. With the development of imaging methods one can expect improvement of unsatisfactory results, considering the detection of primary neoplastic foci.
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23
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Jain A, Srivastava MK, Pawaskar AS, Shelley S, Elangovan I, Jain H, Pandey S, Kalal S, Amalachandran J. Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin. Indian J Nucl Med 2015; 30:213-20. [PMID: 26170563 PMCID: PMC4479909 DOI: 10.4103/0972-3919.158529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). Materials and Methods: A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. Results: PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. Conclusions: F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT.
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Affiliation(s)
- Avani Jain
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Alok Suresh Pawaskar
- Department of Nuclear Medicine and PET-CT, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
| | - Simon Shelley
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Indirani Elangovan
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Hasmukh Jain
- Department of Nuclear Medicine, Kailash Cancer Hospital and Research Institute, Vadodara, Gujarat, India
| | - Somnath Pandey
- Department of Nuclear Medicine, Eko Diagnostic Center, Kolkata, West Bengal, India
| | - Shilpa Kalal
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
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24
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Role of 2-Fluoro-2-Deoxyglucose PET/Computed Tomography in Carcinoma of Unknown Primary. PET Clin 2015; 10:297-310. [DOI: 10.1016/j.cpet.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Economopoulou P, Mountzios G, Pavlidis N, Pentheroudakis G. Cancer of Unknown Primary origin in the genomic era: Elucidating the dark box of cancer. Cancer Treat Rev 2015; 41:598-604. [PMID: 26033502 DOI: 10.1016/j.ctrv.2015.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 12/18/2022]
Abstract
Cancer of Unknown Primary (CUP) comprises a heterogeneous disease group with diagnosis of metastatic malignancy in the absence of an identifiable primary site after diagnostic work up. CUP may either resemble a specific primary tumor site sharing common clinicopathological characteristics and prognosis, or present as a distinct disease entity with undifferentiated pathological features, usually bearing dismal prognosis. Diagnosis and management have traditionally been based on clinicopathological characteristics and therapeutic strategies have been mainly empirical. In the last decade, the advent of massive gene sequencing and the advances in genomic technologies have shed light on the genomic landscape of CUP. Several gene panel tests are currently commercially available and are used in an effort to correlate the genomic characteristics of a specific CUP tumor to those of a known primary tumor, guiding thus therapeutic management. Nevertheless, these efforts are hampered by the rarity of CUP and the inability to validate the results of such tests due to the paucity of randomized clinical trials. In the current work, we provide an overview of CUP with emphasis on the impact of the genome sequencing technologies on diagnosis and management of these tumors. We also discuss potential implications of genomics for the future treatment of CUP and address the challenges of the implementation of these therapeutic strategies in routine clinical practice.
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Affiliation(s)
- Panagiota Economopoulou
- Medical Oncology Unit, 2nd Department of Internal Medicine, Propaideutic, Attikon University Hospital, Haidari, Greece
| | - Giannis Mountzios
- Medical Oncology Dpt, University of Athens School of Medicine, Athens, Greece
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26
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Alkabie S, Bello B, Martinez RF, Geis WP, Ballo MS. Metastatic Adenocarcinoma of Unknown Origin Presenting as Small Bowel Perforation. J Investig Med High Impact Case Rep 2015; 3:2324709615577415. [PMID: 26425638 PMCID: PMC4586912 DOI: 10.1177/2324709615577415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Metastatic malignant tumors that originate from occult primaries are defined as “cancers of unknown origin.” We herein present the case of a 59-year-old man who presented with small bowel perforation secondary to metastatic adenocarcinoma of an unknown primary site. Imaging exhibited two pulmonary nodules, neither of which was dominant, along with mediastinal and retroperitoneal lymphadenopathy. Immunohistochemical profiling of the small bowel biopsy specimens revealed the tumor was most likely pulmonary in origin.
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Affiliation(s)
- Samir Alkabie
- Northwest Hospital, Randallstown, MD, USA
- Saba University School of Medicine, Devens, MA, USA
| | - Brian Bello
- Northwest Hospital, Randallstown, MD, USA
- Sinai Hospital, Baltimore, MD, USA
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27
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Karunanithi S, Kumar G, Sharma P, Bal C, Kumar R. Potential role of (18)F-2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography imaging in patients presenting with generalized lymphadenopathy. Indian J Nucl Med 2015; 30:31-8. [PMID: 25589803 PMCID: PMC4290063 DOI: 10.4103/0972-3919.147532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Generalized lymphadenopathy is a common and often vexing clinical problem caused by various inflammatory, infective and malignant diseases. We aimed to review briefly and highlight the potential role of 18F-2-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in such patients. 18F-FDG PET/CT can play an important role in the management of generalized lymphadenopathy. It can help in making an etiological diagnosis; can detect extranodal sites of involvement and employed for monitoring response to therapy.
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Affiliation(s)
- Sellam Karunanithi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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28
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A mini review on cancer of unknown primary site: A clinical puzzle for the oncologists. J Adv Res 2014; 6:375-82. [PMID: 26257935 PMCID: PMC4522587 DOI: 10.1016/j.jare.2014.11.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/19/2014] [Accepted: 11/14/2014] [Indexed: 01/17/2023] Open
Abstract
Cancer of unknown primary (CUP) is a well recognized clinical syndrome, accounting for 3–5% of all malignancies. It is characterized as a disease with an early dissemination of metastases without a primary detected site after extensive laboratory and clinical investigations. CUP is divided into the favorable and unfavorable groups based on histopathological and clinical manifestations. Adenocarcinoma of various differentiations is the commonest histopathological subtype. Favorable groups are treated with local or systemic treatment and some of them are enjoying long-term survival. On the contrary, unfavorable groups are treated with empirical chemotherapy having usually a dismal prognosis. Gene-profiling microarray diagnosis has a high diagnostic sensitivity, but its predictive or prognostic value remains uncertain.
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29
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Collado Martín R, García Palomo A, de la Cruz Merino L, Borrega García P, Barón Duarte FJ. Clinical guideline SEOM: cancer of unknown primary site. Clin Transl Oncol 2014; 16:1091-7. [PMID: 25392080 PMCID: PMC4239766 DOI: 10.1007/s12094-014-1244-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Abstract
Cancer of unknown primary site is a histologically confirmed cancer which is manifested in advanced stage, with no identifiable primary site after the use of standard diagnostic procedures. Patients are initially placed into one of categories based upon the examination of the initial biopsy: adenocarcinoma, squamous cell carcinoma, neuroendocrine carcinoma and poorly differentiated carcinoma. Appropriate patient management requires an understanding of several clinicopathologic features that help to identify several subsets of patients with more responsive tumors.
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Affiliation(s)
- R Collado Martín
- Medical Oncology Department, Hospital San Pedro de Alcántara, Avda Pablo Naranjo S/N, 10003, Cáceres, Spain
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30
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Winter MC, Haberkorn U, Kratochwil C. [Importance of nuclear medicine diagnostics in CUP syndrome]. Radiologe 2014; 54:134-9. [PMID: 24445408 DOI: 10.1007/s00117-013-2548-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CLINICAL/METHODICAL ISSUE The diagnostic work-up in patients with carcinoma of unknown primary (CUP) syndrome is extensive, highly time-consuming and cost-intensive and ultimately often fails to detect a primary site. STANDARD RADIOLOGICAL METHODS In this context chest X-ray and computed tomography (CT) have been used as standard imaging modalities in CUP syndrome. METHODOLOGICAL INNOVATIONS Since the introduction of positron emission tomography (PET) evaluation of tumor vitality has become possible. Furthermore, PET-CT hybrid scanners allow the combination of functional and morphological imaging. PERFORMANCE Several meta-analyses have reported an additional overall detection rate between 24.5 % and 44 % by either PET or PET-CT. Metastatic localization (cervical versus extracervical) did not influence the performance. The sensitivity was usually high (> 80 %) but specificity was moderate ranging from 68 % to 88 % at best. If mentioned, the results obtained by fluorodeoxyglucose (FDG)-PET significantly changed the clinical management in approximately one third of the patients studied. In a direct comparison with PET alone, PET-CT did not depict significantly more primary tumors but was able to reduce false positive findings. ACHIEVEMENTS To determine the real additional value of PET-CT in the diagnosis of CUP syndrome large prospective studies with more uniform inclusion criteria are needed. Despite the capabilities of FDG-PET-CT there is as yet no evidence that a potentially improved diagnostic algorithm is translated into a better patient outcome. PRACTICAL RECOMMENDATIONS Nevertheless, FDG-PET-CT should be performed in all CUP patients where conventional imaging failed to detect a primary site or the results are equivocal. In CUP patients with cervical lymph node metastases PET-CT should be carried out prior to panendoscopy to reduce the number of false negative biopsies.
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Affiliation(s)
- M C Winter
- Abteilung für Nuklearmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland,
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31
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Algin E, Ozet A, Gumusay O, Cetin B, Akdemir UO, Benekli M, Coskun U, Uner A, Kapucu O, Buyukberber S. 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; 28:891-6. [DOI: 10.1007/s12149-014-0896-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/03/2014] [Indexed: 12/22/2022]
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32
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Shah SM, Rosenthal MH, Griffin GK, Jacobsen ED, McCleary NJ. An Aggressive Presentation of Colorectal Cancer With an Atypical Lymphoproliferative Pattern of Metastatic Disease: A Case Report and Review of the Literature. Clin Colorectal Cancer 2014; 13:e5-e11. [DOI: 10.1016/j.clcc.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/06/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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33
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(68)Ga-DOTATATE PET/CT in the evaluation of patients with neuroendocrine metastatic carcinoma of unknown origin. Ann Nucl Med 2014; 28:638-45. [PMID: 24862238 DOI: 10.1007/s12149-014-0856-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/06/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE There is little evidence regarding the role of (68)Ga-DOTATATE PET/CT for the identification of primary tumors in patients with metastatic neuroendocrine carcinoma of unknown primary. The aim of this study is to assess the value of this technique in the mentioned clinical scenario. METHODS We retrospectively studied twenty-nine patients (mean age 59.5 ± 10.6 years; female 17) with pathologically proven neuroendocrine metastases. In all cases conventional imaging was negative for primary tumor identification. (68)Ga-DOTATATE PET/CT was performed with a mean dose of 104.2 ± 18.8 MBq, using a 64-slice PET/CT with time-of-flight correction. A team of an experienced radiologist and a nuclear medicine physician evaluated the images. The maximum SUV (SUVm) was measured in all abnormal foci. Histopathology (when available) and/or clinical follow-up with correlative imaging was considered as reference standard. RESULTS (68)Ga-DOTATATE PET/CT identified the primary tumor in 17/29 (59%) patients in the following locations: pancreas (n = 7), ileum (n = 7), duodenum (n = 1), colon (n = 1) and stomach (n = 1). In this population a significant correlation was found between SUVm of primary tumor and metastases (r = 0.815, P < 0.0001). Furthermore, additional sites of unsuspected metastases were demonstrated in 9 patients of this group and in 6 patients in whom no primary tumor was localized, mainly in lymph nodes and mesentery. Pathology confirmation was obtained in 7 patients who underwent surgery, whereas in the remaining 10 patients, correlative imaging and follow-up confirmed primary tumor localization. CONCLUSIONS (68)Ga-DOTATATE PET/CT is a clinically useful imaging technique for the localization of primary tumors in patients with neuroendocrine metastatic carcinoma of unknown origin with the potential of having a significant impact in patient management and therapy planning.
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Kim W, Han I, Kang S, Lee SA, Kim HS. Non-spine bone metastasis as an initial manifestation of cancer in Korea. J Korean Med Sci 2014; 29:357-62. [PMID: 24616584 PMCID: PMC3945130 DOI: 10.3346/jkms.2014.29.3.357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022] Open
Abstract
Non-spine bone metastasis accounts for approximately 20% of all skeletal metastases, but little data have been published that focused on bone metastasis to the pelvis and extremities as an initial manifestation of cancer. We determined 1) clinicopathologic characteristics of patients who presented with non-spine bone metastasis of unknown primary malignancy, and 2) process by which the diagnosis of primary cancer was made. We retrospectively reviewed 84 patients with bone metastasis of unknown primary cancer site at the time of presentation. The study population consisted of 56 men and 28 women, with a mean age of 59.1 yr (17.5-85.6 yr). The average follow-up period was 20.8 months (1-120 mo). Primary cancer site was identified in 79 patients (94.0%), and was determined to be the lung (46.4%), kidney (13.1%), liver (9.5%), thyroid (8.3%), and prostate (4.8%). Five-year overall survival rate was 28.0%. Multiple bone metastases, distant organ metastasis, and multiple bone with organ metastases were the significant prognostic factors in univariate analysis. Multiple bone metastases remained significant after multivariate analysis (P = 0.008). Lung cancer is the most common site of primary cancer, and patients with multiple bone metastases have a poor prognosis, possibly due to disseminated cancer and a greater tumor burden.
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Affiliation(s)
- Wanlim Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
- Musculoskeletal Tumor Center, Seoul National University Hospital, Seoul, Korea
| | - Seungcheol Kang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sang A Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
- Musculoskeletal Tumor Center, Seoul National University Hospital, Seoul, Korea
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Bagan P, Mordant P, Pricopi C, Le Pimpec Barthes F, Riquet M. [Metastatic thoracic lymph node carcinoma from extra-thoracic malignancy or from unknown primary site]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:363-367. [PMID: 24210159 DOI: 10.1016/j.pneumo.2013.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
Malignant mediastinal lymph nodes without pulmonary disease may be lymphomatous or the metastases from thoracic or extrathoracic malignancy. More rarely, metastatic lymph nodes are without primary site. Surgery is generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes. Radical surgery consisting in lymphadenectomy can be effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed in our experience and in several case reports long-term good results in such cases. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.
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Affiliation(s)
- P Bagan
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France.
| | - P Mordant
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
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Fernández-Antón Martínez M, Parra-Blanco V, Avilés Izquierdo J, Suárez Fernández R. Cutaneous Metastases of Internal Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Population-based incidence, treatment and survival of patients with peritoneal metastases of unknown origin. Eur J Cancer 2013; 50:50-6. [PMID: 24011935 DOI: 10.1016/j.ejca.2013.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/02/2013] [Accepted: 08/12/2013] [Indexed: 01/11/2023]
Abstract
AIM Until recently, peritoneal metastases (PM) were regarded as an untreatable condition, regardless of the organ of origin. Currently, promising treatment options are available for selected patients with PM from colorectal, appendiceal, ovarian or gastric carcinoma. The aim of this study was to investigate the incidence, treatment and survival of patients presenting with PM in whom the origin of PM remains unknown. METHODS Data from patients diagnosed with PM of unknown origin during 1984-2010 were extracted from the Eindhoven Cancer Registry. European age-standardised incidence rates were calculated and data on treatment and survival were analysed. RESULTS In total 1051 patients were diagnosed with PM of unknown origin. In 606 patients (58%) the peritoneum was the only site of metastasis, and 445 patients also had other metastases. Chemotherapy usage has increased from 8% in the earliest period to 16% in most recent years (p=.016). Median survival was extremely poor with only 42days (95% confidence interval (CI) 39-47days) and did not change over time. Median survival of patients not receiving chemotherapy was significantly worse than of those receiving chemotherapy (36 versus 218days, p<.0001). CONCLUSION The prognosis of PM of unknown origin is extremely poor and did not improve over time. Given the recent progress that has been achieved in selected patients presenting with PM, maximum efforts should be undertaken in order to diagnose the origin of PM as accurately as possible. Potentially effective treatment strategies should be further explored for patients in whom the organ of origin remains unknown.
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Deonarine P, Han S, Poon FW, de Wet C. The role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in the management of patients with carcinoma of unknown primary. Scott Med J 2013; 58:154-62. [PMID: 23960054 DOI: 10.1177/0036933013496958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Carcinoma of unknown primary is one of the ten most frequent cancers worldwide. Its median survival time is less than 10 months. Detecting primary tumour locations and/or occult metastatic lesions may inform definitive treatment and improve patients’ prognosis. We aimed to determine: (1) the sensitivity, specificity and accuracy of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography; (2) its detection rate of primary tumour locations and occult metastases and (3) factors associated with improved survival times. Methods We retrospectively reviewed all cases in the West of Scotland for the period 1 December 2007 to 31 May 2011 that met all our selection criteria: (1) diagnosis of carcinoma of unknown primary; (2) a thorough but negative ‘work-up’ and (3) 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography report. Statistical methods included frequencies, Kaplan-Meier graphs and log-rank tests to compare survival times. Results 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected primary tumour sites in 19/51 (37.3%) and occult metastases in 28/51 (54.9%) of eligible patients. Its sensitivity, specificity and accuracy were 79.2%, 70.4% and 74.5%, respectively; 20/51 (39.2%) patients died during the study period with a median survival of 8.4 months (range 21.4, SD ± 6.2). The number of metastatic locations was strongly associated with survival ( p = 0.002), but detection of a primary tumour site ( p = 0.174) or histopathology ( p = 0.301) was not. Conclusion 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected occult metastatic sites in the majority and a primary cancer location in a substantial minority of patients. Our results were comparable with international literature and may indicate that 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography have an early role to improve the accuracy of cancer staging and to optimise carcinoma of unknown primary management.
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Affiliation(s)
- P Deonarine
- Radiology Consultant, Radiology Department, Glasgow Royal Infirmary, UK
| | - S Han
- Consultant Physician, Glasgow Royal Infirmary, UK
- Consultant Physician, West of Scotland PET Centre, Gartnavel General Hospital, UK
| | - FW Poon
- Radiology Consultant, Radiology Department, Glasgow Royal Infirmary, UK
- Radiology Consultant, West of Scotland PET Centre, Gartnavel General Hospital, UK
| | - C de Wet
- Associate Adviser in Postgraduate GP Education, NHS Education for Scotland, UK
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Cancer of unknown primary: a population-based analysis of temporal change and socioeconomic disparities. Br J Cancer 2013; 109:1318-24. [PMID: 23860528 PMCID: PMC3778275 DOI: 10.1038/bjc.2013.386] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/15/2013] [Accepted: 06/24/2013] [Indexed: 01/26/2023] Open
Abstract
Background: Cancer of unknown primary (CUP) is the fourth most common cause of cancer death. With advanced diagnostics and treatments, we investigated the proportion of cancers diagnosed as CUP, treatment outcomes and association with socioeconomic disparities. Methods: We analysed trends in CUP diagnosis and outcome within the Surveillance, Epidemiology, and End Results registry between 1973 and 2008. Results: The percentage of all cancers diagnosed as CUP has decreased over time comprising <2% of cancers since 2007. A higher proportion of CUP was diagnosed in the elderly, females, blacks and residents of less affluent or less educated counties. Median survival of all CUP patients was 3 months, with no improvement over time. The 5-year survival significantly improved in those with squamous histology (squamous cell carcinoma; SCC) but only marginally in non-SCC. Factors associated with a longer survival on multivariate analysis included white race; female; <65 years old; most recent decade at diagnosis; SCC; married; a histological diagnosis; and treatment with radiotherapy (all P<0.001). Despite the improvement in survival with radiotherapy, its use was less frequent in females and blacks. Conclusion: The percentage of cancers diagnosed as CUP is decreasing but prognosis remains poor, particularly in non-SCC CUP. However, significant socioeconomic disparities exist in diagnosis and survival, suggesting inequalities in access to diagnostic investigations and treatment.
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Cancer of unknown primary sites: what radiologists need to know and what oncologists want to know. AJR Am J Roentgenol 2013; 200:484-92. [PMID: 23436835 DOI: 10.2214/ajr.12.9363] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In this article, we review the role of imaging in cancer of unknown primary site (CUP) diagnosis and management and the utility of immunohistochemistry, serum tumor markers, and molecular profiling in the optimized care of CUP patients. CONCLUSION With advances in imaging, pathology, and molecular medicine, the diagnosis and management of CUP have evolved into more personalized and site-specific therapies. A multidisciplinary integrated approach among oncologists, pathologists, and radiologists is extremely important.
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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 2012; 57:65-71. [PMID: 23374557 DOI: 10.1111/j.1754-9485.2012.02441.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 05/11/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of the study is to investigate the clinical value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in detecting the primary sites in patients with carcinoma of unknown primary (CUP). METHODS The reports of FDG PET/CT scans of 164 patients with CUP syndrome in consecutive 2589 patients referred to our department from January 2006 to June 2010 were retrospectively reviewed. The final results were obtained from the pathologic reports, other imaging modalities diagnoses and clinical follow-up data. RESULTS There were 142 cases in the results analysis, as 19 patients were lost to follow-up and three patients were excluded. FDG PET/CT successfully detected primary tumours in 67 (47.2%) out of 142 patients. Among this group, 53 were pathologically proved and 17 patients were confirmed by clinical follow-up. The primary sites of 38 (56.7%) were in lung, eight (11.9%) in nasopharynx and 13 (19.4%) in digestive system. Six patients were misdiagnosed by FDG PET/CT scan. FDG PET/CT could not detect the primary lesion in 66 patients, and three primary tumours were identified by conventional work-up after negative FDG PET/CT scan. The accuracy, sensitivity and specificity of FDG PET/CT scan in detecting the primary site in this study were 93.7%, 95.7% and 91.7%, respectively. FDG PET/CT scan changed the medical management of about 33.8% of 142 CUP patients. CONCLUSION FDG PET/CT whole-body imaging is a valuable tool in detecting the primary tumour of patients with CUP site.
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Affiliation(s)
- Guohui Wang
- Department of Medical Imaging and Interventional Radiology, Cancer Center and State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, China
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Herrak L, Jahnaoui N, Hammi S, El Asri N, Achachi L, El Ftouh M, Mansouri H, El Fassy Fihry MT. [Cerebral metastasis of a "ghost" bronchopulmonary tumor]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:243-248. [PMID: 22244468 DOI: 10.1016/j.pneumo.2011.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/16/2011] [Accepted: 09/19/2011] [Indexed: 05/31/2023]
Abstract
Carcinoma of unknown primary (CUP) is the metastasis of epithelial malignancy whose origin remains unknown. Bronchial carcinoma is the most common cause (45%), however, in more than a quarter of cases, its origin is unknown and the choice of therapy often justifies a histopathological precision brought by the immuno-histochemistry. We present a rare case of cerebral metastasis, revealing an unknown lung cancer after a comprehensive review. This is a patient aged 53 years, chronic smoker, who presented a year and a half ago a sudden loss of consciousness with afebrile tonic-clonic seizure of spontaneous resolution. Clinical examination was unremarkable. Brain imaging by MRI has objectified the presence of two parietal tissue formations, which stereotactic biopsy with histological and immuno-histochemical favored metastasis of lung adenocarcinoma origin. An etiologic in search of the primitive lung remained negative (chest X-ray of face, chest CT and bronchoscopy with sampling upper gastrointestinal endoscopy). The rest of the etiologic, looking for another primitive, remained negative. The diagnosis of a bronchogenic carcinoma with brain metastasis is therefore withheld. The patient received two brain radiotherapies (gamma kniff) with regression of the two nodular formations. We have not given specific treatment and have called for very close monitoring of the patient who remained stable after 18 months. Through this observation, we stress the interest of the histology and immuno-histochemistry of carcinoma of unknown primary (CUP) to the diagnosis, guide therapy and determine prognosis.
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Affiliation(s)
- L Herrak
- Service de pneumologie, Chu Ibn-Sina, Rabat, Morocco.
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Fernández-Antón Martínez MC, Parra-Blanco V, Avilés Izquierdo JA, Suárez Fernández RM. Cutaneous metastases of internal tumors. ACTAS DERMO-SIFILIOGRAFICAS 2012; 104:841-53. [PMID: 22853962 DOI: 10.1016/j.ad.2012.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/23/2012] [Accepted: 06/02/2012] [Indexed: 01/10/2023] Open
Abstract
Cutaneous metastases are relatively rare in clinical practice and their diagnosis requires a high index of suspicion because clinical findings can be subtle. These metastases reveal the presence of disseminated malignant disease and can lead to the diagnosis of unsuspected internal tumors or the spread or recurrence of an already diagnosed tumor. Early recognition of cutaneous metastases can facilitate prompt and accurate diagnosis resulting in early treatment; however, they are generally indicative of a poor prognosis. Some tumors have a predilection to metastasize to specific areas. Recognition of these patterns provides essential information that can guide the search for the underlying tumor.
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Spencer CR, Skilbeck CJ, Thway K, Nutting CM. Lymphoepithelial carcinoma of the parotid gland: a rare neck lump. JRSM SHORT REPORTS 2012; 3:28. [PMID: 22666525 PMCID: PMC3365787 DOI: 10.1258/shorts.2012.011161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cheka R Spencer
- Head and Neck Unit , The Royal Marsden Hospital , Fulham Road, London SW3 6JJ , UK
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⁶⁸Ga-DOTANOC PET/CT in patients with carcinoma of unknown primary of neuroendocrine origin. Clin Nucl Med 2012; 37:245-51. [PMID: 22310250 DOI: 10.1097/rlu.0b013e31823ea730] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the role of ⁶⁸Ga-DOTANOC (⁶⁸Gallium-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI³-octreotide) PET/CT for localization of the primary tumor in patients with carcinoma of unknown primary of neuroendocrine origin. MATERIAL AND METHODS Twenty patients (median age, 55 years; male 10) with histopathologically proven metastatic neuroendocrine tumor and no localization of primary tumor on conventional imaging were included in the study. PET/CT was done after injection of 132-222 MBq (4-6 mCi) of ⁶⁸Ga-DOTANOC. Images were evaluated by 2 experienced nuclear medicine physicians both qualitatively as well as quantitatively (maximum standardized uptake value). Histopathology (when available) and/or follow-up imaging with biochemical markers were taken as reference standard. RESULTS ⁶⁸Ga-DOTANOC PET/CT localized the primary tumor in 12/20 (60%) patients. Midgut was the most common site of primary tumor (n = 9); duodenum (4), ileum (4), and colon (1). In 1 patient each the primary was localized to the pancreas, stomach, and lung. In these 12 patients, significant correlation was found between maximum standardized uptake value of primary tumor and metastasis (ρ = 0.615; P = 0.041). Even in patients in whom no primary tumor was localized, additional sites of metastatic disease were observed when compared with conventional imaging, mostly in lymph nodes and bones. There was a change in management in 3/20 patients (15%), who underwent surgery. In the remaining 17 patients, demonstration of somatostatin receptor expression by PET/CT made them suitable candidate for peptide receptor radionuclide therapy. CONCLUSION ⁶⁸Ga-DOTANOC PET/CT seems to be a promising modality for detecting primary tumor in patients with carcinoma of unknown primary of neuroendocrine origin.
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Abstract
Cancer of unknown primary site (CUP) is a well recognised clinical disorder, accounting for 3-5% of all malignant epithelial tumours. CUP is clinically characterised as an aggressive disease with early dissemination. Diagnostic approaches to identify the primary site include detailed histopathological examination with specific immunohistochemistry and radiological assessment. Gene-profiling microarray diagnosis has high sensitivity, but further prospective study is necessary to establish whether patients' outcomes are improved by its clinical use. Metastatic adenocarcinoma is the most common CUP histopathology (80%). CUP patients are divided into subsets of favourable (20%) and unfavourable (80%) prognosis. Favourable subsets are mostly given locoregional treatment or systemic platinum-based chemotherapy. Responses and survival are similar to those of patients with relevant known primary tumours. Patients in unfavourable subsets are treated with empirical chemotherapy based on combination regimens of platinum or taxane, but responses and survival are generally poor.
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Affiliation(s)
- Nicholas Pavlidis
- Department of Medical Oncology, School of Medicine, University of Ioannina, Ioannina, Greece.
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Kelly P, Das P, Varadhachary GR, Fontanilla HP, Krishnan S, Delclos ME, Jhingran A, Eifel PJ, Crane CH. Role of definitive radiation therapy in carcinoma of unknown primary in the abdomen and pelvis. Int J Radiat Oncol Biol Phys 2012; 82:2012-7. [PMID: 21640510 DOI: 10.1016/j.ijrobp.2011.03.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/09/2011] [Accepted: 03/17/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Carcinoma of unknown primary (CUP) in the abdomen and pelvis is a heterogeneous group of cancers with no standard treatment. Considered by many to be incurable, these patients are often treated with chemotherapy alone. In this study, we determined the effectiveness of radiation therapy in combination with chemotherapy in patients with CUP in the abdomen and pelvis. PATIENTS AND METHODS Medical records were reviewed for 37 patients with CUP treated with radiation therapy for disease located in the soft tissues and/or nodal basins of the abdomen and pelvis at the University of Texas M.D. Anderson Cancer between 2002 and 2009. All patients underwent chemotherapy, either before or concurrent with radiation therapy. Patients were selected for radiation therapy on the basis of histologic type, disease extent, and prior therapy response. Twenty patients underwent definitive radiation therapy (defined as radiation therapy targeting all known disease sites with at least 45 Gy) and 17 patients underwent palliative radiation therapy. Only 6 patients had surgical resection of their disease. Patient and treatment characteristics were extracted and the endpoints of local disease control, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity incidence were analyzed. RESULTS The 2-year PFS and OS rates for the entire cohort were 32% and 57%, respectively. However, in patients treated with definitive radiation therapy, the rates were 48% and 76%, and 7 patients lived more than 3 years after treatment with no evidence of disease progression. Nevertheless, radiation-associated toxicity was significant in this cohort, as 40% experienced Grade 2 or higher late toxicities. CONCLUSIONS The use of definitive radiation therapy should be considered in selected patients with CUP in the soft tissues or nodal basins of the abdomen and pelvis.
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Affiliation(s)
- Patrick Kelly
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ok TJ, Cho MS, Jang SJ, Park HS, Park HS, Park SJ, Yoon SK, Lee HS, Baek CH, Kim GU, Kim D, Hong Y, Seo JB, Oh YM. Microvascular Pulmonary Tumor Embolism Detected by Perfusion Images of Dual-Energy Computed Tomography. Tuberc Respir Dis (Seoul) 2012. [DOI: 10.4046/trd.2012.72.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tae Jin Ok
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun-Joo Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han-Seung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwan Sung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Jeong Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kyo Yoon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Su Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chung Hee Baek
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwang Un Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalyong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoonki Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fizazi K, Greco FA, Pavlidis N, Pentheroudakis G. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22 Suppl 6:vi64-8. [PMID: 21908507 DOI: 10.1093/annonc/mdr389] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris, Villejuif, France
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