| Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup. | |
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MedLine Citation:
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PMID: 19841343 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess the efficacy of various diagnostic modalities in detecting occult primary tumor location. DESIGN: Retrospective medical record study. SETTING: Academic head and neck oncology practice. PATIENTS: A total of 183 consecutive patients with metastatic carcinoma of the neck from an unknown primary tumor during a 10-year period, after exclusion of those with previous history of head and neck cancer, a primary tumor site evident on physical examination, or primary tumors of the neck. MAIN OUTCOME MEASURES: Identification of primary tumor location by various imaging modalities and panendoscopy with directed biopsies. RESULTS: Primary tumor location was identified in 84 patients (45.9%). Preoperative imaging (computed tomography [CT], magnetic resonance imaging, positron emission tomography [PET], and/or PET-CT fusion scan) identified sites suggestive of primary tumor location in 69 patients. Subsequent directed biopsy of these sites yielded positive results in 42 cases (60.9%). The rate of successful identification of a primary tumor for each of the imaging modalities was as follows: CT scan of the neck, 14 of 146 patients (9.6%); magnetic resonance imaging of the neck, 0 of 13 patients (0%); whole-body PET scan, 6 of 41 patients (14.6%); and PET-CT fusion study, 23 of 52 patients (44.2%) (P = .001). The highest yield in identifying primary tumor sites was obtained in patients who had undergone PET-CT plus panendoscopy with directed biopsies with or without tonsillectomy: 31 of 52 patients (59.6%). CONCLUSION: Diagnostic workup including PET-CT, alongside panendoscopy with directed biopsies including bilateral tonsillectomy, offers the greatest likelihood of successfully identifying occult primary tumor location. |
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Authors:
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Joshua D Waltonen; Enver Ozer; Nathan C Hall; David E Schuller; Amit Agrawal |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Archives of otolaryngology--head & neck surgery Volume: 135 ISSN: 1538-361X ISO Abbreviation: Arch. Otolaryngol. Head Neck Surg. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-20 Completed Date: 2009-12-03 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8603209 Medline TA: Arch Otolaryngol Head Neck Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1024-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH 43210, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Biopsy Diagnostic Imaging* Endoscopy Female Head and Neck Neoplasms / diagnosis*, secondary* Humans Male Middle Aged Neck Dissection Neoplasms, Unknown Primary / diagnosis*, pathology Physical Examination Predictive Value of Tests Retrospective Studies Sensitivity and Specificity |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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