This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (15)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Oncology  • Head & Neck Cancer  • Neoplasms of Head & Neck  • Radiology of Head & Neck  • Alert me on articles by topic

Frank R. Miller, MD; David Hussey, MD; Mural Beeram, MD; Tony Eng, MD; H. Stan McGuff, DDS; Randal A. Otto, MD

Arch Otolaryngol Head Neck Surg. 2005;131:626-629.

Objective  To assess the role of positron emission tomography (PET) in the management of unknown primary carcinoma of the head and neck region.

Design and Setting  Prospective case series at an academic medical center.

Patients  Twenty-six patients with an open excisional biopsy or a fine-needle aspiration biopsy finding that confirmed squamous cell carcinoma of the cervical lymph nodes and no visible primary tumor (as determined by results of a comprehensive physical examination and computed tomography and/or magnetic resonance imaging) underwent PET. The standard evaluation consisted of a comprehensive head and neck examination that included fiberoptic laryngoscopy/nasopharyngoscopy, computed tomography and/or magnetic resonance imaging, and PET followed by panendoscopy with selected biopsies and tonsillectomy.

Main Outcome Measures  Sensitivity, specificity, and positive and negative predictive values of PET to detect an occult primary tumor.

Results  The PET detected 8 occult primary tumors in 26 patients (detection rate, 30.8%). Four occult primary tumors (2 at the base of the tongue and 2 in the tonsil) were detected during routine panendoscopy with negative PET findings. The sensitivity of PET was 66.0%, with a specificity of 92.9%. The positive predictive value was 88.8%, and the negative predictive value was 76.5%.

Conclusions  Positron emission tomography can be a valuable tool to identify a subset of patients with an occult primary tumor in the head and neck region. In addition, it can be used to screen for primary tumors below the clavicle. Early identification of the primary tumor may allow for more accurate tumor staging and targeted radiotherapy to minimize adverse effects and complications. A normal PET finding, however, does not eliminate the need for a careful panendoscopy with directed biopsies and tonsillectomy.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Miller and Otto), Radiation Oncology (Drs Hussey and Eng), Medical Oncology (Dr Beeram), and Pathology (Dr McGuff), The University of Texas Health Science Center at San Antonio.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Recommendations on the Use of 18F-FDG PET in Oncology
Fletcher et al.
JNM 2008;49:480-508.
ABSTRACT | FULL TEXT