Lymph node metastasis of squamous cell carcinoma from an unknown primary in the upper and middle neck: impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography

Purpose: The purpose of this study was to assess the potential of F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging for detection of the primary tumor and its impact on treatment planning in patients presenting with cancer of unknown primary and squamous cell carcinoma (SCC)-positive cervical lymph nodes of the upper and middle neck. Methods: The study population consisted of 18 consecutive patients with biopsy-proven SCC involving lymph nodes of the upper and middle neck region and negative conventional diagnostic procedures with regard to the location of the primary. All patients underwent FDG-PET/CT according to a standard procedure in search for the primary, unidentified tumor. Results: In none of the patients FDG-PET/CT was able to indicate a primary tumor localization. Although FDGPET/CT did identify all sites of known lymph node involvement, neither additional sites of lymph node involvement nor sites of distant metastases were identified. Accordingly, FDG-PET/CT did not impact patient treatment planning. Conclusions: In this series, including patients suffering from lymph node metastases by an SCC of unknown primary in the upper and middle neck, FDG-PET/CT was unable to identify a primary tumor. In addition, FDGPET/CT did not modify the treatment planning in any of the patients studied.

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