Evaluating the Utility of 18 F-FDG PET/CT in Cancer of Unknown Primary.

Autor:	Sivakumaran T; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; tharani.sivakumaran@petermac.org.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia., Cardin A; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.; Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Callahan J; Melbourne Theranostic Innovation Centre, Melbourne, Victoria, Australia., Wong HL; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia., Tothill RW; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.; Department of Clinical Pathology and University of Melbourne Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia; and., Hicks RJ; Melbourne Theranostic Innovation Centre, Melbourne, Victoria, Australia.; University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia., Mileshkin LR; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Journal of nuclear medicine : official publication, Society of Nuclear Medicine [J Nucl Med] 2024 Oct 01; Vol. 65 (10), pp. 1557-1563. Date of Electronic Publication: 2024 Oct 01.
DOI:	10.2967/jnumed.123.267274
Abstrakt:	Cancer of unknown primary (CUP) represents a heterogeneous group of metastatic tumors for which standardized diagnostic work-up fails to identify the primary site. We aimed to describe the Peter MacCallum Cancer Centre experience with 18 F-FDG PET/CT in extracervical CUP with respect to detection of a primary site and its impact on management. A secondary aim was to compare overall survival (OS) in patients with and without a detected primary site. Methods: CUP patients treated between 2014 and 2020 were identified from medical oncology clinics and 18 F-FDG PET/CT records. Information collated from electronic medical records included the suspected primary site and treatment details before and after 18 F-FDG PET/CT. Clinicopathologic details and genomic analysis were used to determine the clinically suspected primary site and compared against 2 independent masked reads of 18 F-FDG PET/CT images by nuclear medicine specialists to determine sensitivity, specificity, accuracy, and the rate of detection of the primary site. Results: We identified 147 patients, 65% of whom had undergone molecular profiling. The median age at diagnosis was 61 y (range, 20-84 y), and the median follow-up time was 74 mo (range, 26-83 mo). Eighty-two percent were classified as having an unfavorable CUP subtype as per international guidelines. 18 F-FDG PET/CT demonstrated a primary site detection rate of 41%, resulted in a change in management in 22%, and identified previously occult disease sites in 37%. Median OS was 16.8 mo for all patients and 104.7 and 12.1 mo for favorable and unfavorable CUP subtypes, respectively ( P < 0.0001). Median OS in CUP patients when using 18 F-FDG PET/CT, clinicopathologic, and genomic information was 19.8 and 8.5 mo when a primary site was detected and not detected, respectively ( P = 0.016). Multivariable analysis of survival adjusted for age and sex remained significant for identification of a potential primary site ( P < 0.001), a favorable CUP ( P < 0.001), and an Eastern Cooperative Oncology Group status of 1 or less ( P < 0.001). Conclusion: 18 F-FDG PET/CT plays a complementary role in CUP diagnostic work-up and was able to determine the likely primary site in 41% of cases. OS is improved with primary site identification, demonstrating the value of access to diagnostic 18 F-FDG PET/CT for CUP patients. (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)
Databáze:	MEDLINE
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