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Occult Primary Tumors of the Head and Neck
Accuracy of Thallium 201 Single-Photon Emission Computed Tomography and Computed Tomography and/or Magnetic Resonance Imaging
S. A. J. M. van Veen, MD;
A. J. M. Balm, MD;
R. A. Valdés Olmos, MD;
C. A. Hoefnagel, MD;
F. J. M. Hilgers, MD;
I. B. Tan, MD;
F. A. Pameijer, MD
Arch Otolaryngol Head Neck Surg. 2001;127:406-411.
Objective To determine the accuracy of thallium 201 single-photon emission computed
tomography (thallium SPECT) and computed tomography and/or magnetic resonance
imaging (CT/MRI) in the detection of occult primary tumors of the head and
neck.
Design Study of diagnostic tests.
Setting National Cancer Institute, Amsterdam, the Netherlands.
Patients and Methods Thirty-two patients with a neck node metastasis of an epithelial tumor
and negative findings by mirror examination at initial presentation were included
in the study. Twenty-nine patients underwent thallium SPECT and CT/MRI before
examination under general anesthesia (EUA). In 3 patients only thallium SPECT
was performed before EUA. Histological confirmation of an occult primary tumor
during EUA was used as the gold standard. Negative radiodiagnostic and nuclear
findings in the upper aerodigestive tract in the presence of a primary carcinoma
other than of the head and neck were interpreted as true-negative findings.
Results For thallium SPECT the following results were recorded: sensitivity,
67%; specificity, 69%; accuracy, 69%; positive predictive value, 33%; and
negative predictive value, 90%. In 1 patient, thallium whole body scan indicated
a primary carcinoma beyond the mucosal lining of the upper aerodigestive tract.
The CT/MRI results were as follows: sensitivity, 71%; specificity, 73%; accuracy,
72%; positive predictive value, 45%; and negative predictive value, 89%.
Conclusions Thallium SPECT and CT/MRI showed comparable results for detection of
occult primary tumors of the head and neck. A potential advantage of thallium
SPECT is that it allows total body screening.
From the Departments of Head and Neck Oncology (Drs van Veen, Balm,
Hilgers, and Tan), Nuclear Medicine (Drs Valdés Olmos and Hoefnagel),
and Radiology (Dr Pameijer), The Netherlands Cancer Institute, Antoni van
Leeuwenhoek Hospital, Amsterdam, the Netherlands.
Corresponding author: A. J. M. Balm, MD, The Netherlands Cancer Institute,
Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
(e-mail: fbalm{at}nki.nl).
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