Download PDF
TumorDiagnostik & Therapie 2014; 35(07): 402-407
DOI: 10.1055/s-0034-1385250
Thieme Onkologie aktuell
© Georg Thieme Verlag KG Stuttgart · New York

PET/CT bei CUP-Syndromen

PET/CT in Cancer of Unknown Primary
D. Hellwig
,
A. P. Hellwig
Further Information

Publication History

Publication Date:
16 October 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Diagnostik bei einer Krebserkrankung unbekannten Ursprungs (CUP-Syndrom) erfordert die interdisziplinäre Kooperation von Onkologen, Pathologen und bildgebenden Disziplinen. Hier werden diagnostische Konzepte und übliche Herausforderungen der Bildgebung dargestellt, bei denen der gezielte Einsatz von PET/CT-Untersuchungen helfen kann. FDG-PET/CT ist zu empfehlen bei Patienten mit lokalisiertem CUP-Syndrom, wenn die herkömmliche Diagnostik einschl. CT den Primarius nicht identifizieren konnte. Die Somatostatin-Rezeptor-PET/CT mit Ga-68-DOTA-konjugierten Peptiden ergänzt die Diagnostik bei CUP-Syndromen mit neuroendokrinen Tumoren.

Abstract

The diagnostic work-up of patients with cancer of unknown primary sites (CUP syndrome) requires the close cooperation between oncologists, pathologists and of imaging disciplines. Here the diagnostic concepts and frequent challenges for the imaging modalities are presented in which PET/CT examinations may help. FDG-PET/CT is recommended in patients with localized CUP syndrome if conventional work-up including CT failed to identify the primary tumour. Somatostatin receptor PET/CT using Ga-68-DOTA-conjugated peptides complements the diagnostic work-up in CUP syndromes with neuroendocrine tumours.

Schlüsselwörter

CUP-Syndrom - PET/CT - FDG - Somatostatin receptor imaging

Key words

cancer of unknown primary sites - PET/CT - FDG - somatostatin receptor imaging
 

  • Literatur

  • 1 Bundesamt für Strahlenschutz. Bekanntmachung der aktualisierten diagnostischen Referenzwerte für nuklearmedizinische Untersuchungen. 2012
    PubMedGoogle Scholar
  • 2 Fizazi K, Greco FA, Pavlidis N. Group EGW et al. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; vi64-vi68
    PubMedGoogle Scholar
  • 3 Francis IR, Cohan RH, McNulty NJ et al. Multidetector CT of the liver and hepatic neoplasms: effect of multiphasic imaging on tumor conspicuity and vascular enhancement. Am J Roentgenol Am J Roentgenol 2003; 5: 1217-1224
    PubMedGoogle Scholar
  • 4 Grau C, Johansen LV, Jakobsen J et al. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 2000; 2: 121-129
    PubMedGoogle Scholar
  • 5 Hainsworth JD, Rubin MS, Spigel DR et al. Molecular gene expression profiling to predict the tissue of origin and direct site-specific therapy in patients with carcinoma of unknown primary site: a prospective trial of the Sarah Cannon research institute. J Clin Oncol 2013; 2: 217-223
    PubMedGoogle Scholar
  • 6 Hübner G, Frick S, Schmieder A. CUP-Syndrom. Taschenbuch Onkologie 2010: Interdisziplinäre Empfehlungen zur Therapie 2010/2011. Dornoff W, Hagemann FG, Preiß J, Schmieder A. Zuckschwerdt Verlag; 2010: 97-101
    Google Scholar
  • 7 Jadvar H. Hepatocellular carcinoma and gastroenteropancreatic neuroendocrine tumors: potential role of other positron emission tomography radiotracers. Semin Nucl Med 2012; 4: 247-254
    PubMedGoogle Scholar
  • 8 Johansen J, Buus S, Loft A et al. Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study. Head Neck 2008; 4: 471-478
    PubMedGoogle Scholar
  • 9 Keller F, Psychogios G, Linke R et al. Carcinoma of unknown primary in the head and neck: comparison between positron emission tomography (PET) and PET/CT. Head Neck 2011; 11: 1569-1575
    PubMedGoogle Scholar
  • 10 Kim KW, Krajewski KM, Jagannathan JP et al. Cancer of unknown primary sites: what radiologists need to know and what oncologists want to know. Am J Roentgenol Am J Roentgenol 2013; 3: 484-492
    PubMedGoogle Scholar
  • 11 Krause BJ, Beyer T, Bockisch A et al. FDG-PET/CT in oncology. German Guideline. Nuklearmedizin 2007; 6: 291-301
    PubMedGoogle Scholar
  • 12 Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol 2009; 3: 731-744
    PubMedGoogle Scholar
  • 13 Moller AK, Loft A, Berthelsen AK et al. A prospective comparison of 18F-FDG PET/CT and CT as diagnostic tools to identify the primary tumor site in patients with extracervical carcinoma of unknown primary site. Oncologist 2012; 9: 1146-1154
    PubMedGoogle Scholar
  • 14 National Comprehensive Cancer Network.(2013). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Occult Primary (Cancer of Unknown Primary [CUP]. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Retrieved 2013-11-25 2013
    PubMedGoogle Scholar
  • 15 Pavlidis N, Fizazi K. Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol 2009; 3: 271-278
    PubMedGoogle Scholar
  • 16 Pavlidis N, Pentheroudakis G. Cancer of unknown primary site. Lancet 2012; 9824: 1428-1435
    PubMedGoogle Scholar
  • 17 Pentheroudakis G, Golfinopoulos V, Pavlidis N. Switching benchmarks in cancer of unknown primary: from autopsy to microarray. Eur J Cancer 2007; 14: 2026-2036
    PubMedGoogle Scholar
  • 18 Prasad V, Ambrosini V, Hommann M et al. Detection of unknown primary neuroendocrine tumours (CUP-NET) using (68)Ga-DOTA-NOC receptor PET/CT. Eur J Nucl Med Mol Imaging 2010; 1: 67-77
    PubMedGoogle Scholar
  • 19 Rudmik L, Lau HY, Matthews TW et al. Clinical utility of PET/CT in the evaluation of head and neck squamous cell carcinoma with an unknown primary: a prospective clinical trial. Head Neck 2011; 7: 935-940
    PubMedGoogle Scholar
  • 20 Sève P, Billotey C, Broussolle C et al. The role of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography in disseminated carcinoma of unknown primary site. Cancer 2007; 2: 292-299
    PubMedGoogle Scholar
  • 21 Taylor MB, Bromham NR, Arnold SE. Carcinoma of unknown primary: key radiological issues from the recent National Institute for Health and Clinical Excellence guidelines. Br J Radiol 2012; 1014: 661-671
    PubMedGoogle Scholar
  • 22 Varadhachary GR, Karanth S, Qiao W et al. Carcinoma of unknown primary with gastrointestinal profile: immunohistochemistry and survival data for this favorable subset. Int J Clin Oncol 2013;
    PubMedGoogle Scholar
  • 23 Varadhachary GR, Talantov D, Raber MN et al. Molecular profiling of carcinoma of unknown primary and correlation with clinical evaluation. J Clin Oncol 2008; 27: 4442-4448
    PubMedGoogle Scholar
  • 24 Wahl RL, Jacene H, Kasamon Y et al. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 2009; 122S-150S
    PubMedGoogle Scholar
  • 25 Yi JH, La ChoiY, Lee SJ et al. Clinical presentation of carcinoma of unknown primary: 14 years of experience. Tumour Biol 2011; 1: 45-51
    PubMedGoogle Scholar
  • 26 Zhu L, Wang N. 18F-fluorodeoxyglucose positron emission tomography-computed tomography as a diagnostic tool in patients with cervical nodal metastases of unknown primary site: a meta-analysis. Surg Oncol 2013; 3: 190-194
    PubMedGoogle Scholar