Value of PET scan compared with MRI scan in detecting occult primary with cervical lymph node metastasis
Journal Title: Medpulse International Journal of ENT - Year 2017, Vol 1, Issue 2
Abstract
Background: Patients with metastatic carcinoma from an unknown primary site represent up to 15% of all patients with cancer who present to medical centres. The overall incidence of unknown primary tumours in the head and neck region ranges from 3% to 7% of all head and neck cancers. The low rate of primary detection has several causes, among which two are most important. First as the primary lesion is usually small, conventional imaging techniques may be difficult to read; this is especially true within the abdomen, pelvis, and head and neck, which are anatomically difficult areas. Objective: To study the value of PET scan compared with MRI scan in detecting occult primary with cervical lymph node metastasis. Materials and Method: The present study was conducted in the Army Hospital (Research and Referral), Delhi Cantt. The patients attending Head and Neck Oncology clinic with metastatic cervical lymph node(s) without evidence of primary by clinical evaluation were enrolled in the present study. Total 27 patients were selected and were analysed. All the selected patients underwent review of their medical history and thorough medical examination. The patients in whom a primary tumour was not detected were accrued into the study and classified as patients with Carcinoma of Unknown Primary Site (CUPS), and they formed the cohort of our study. All the study patients were subjected to ultrasonography of the abdomen, CT scan of the neck and chest and panendoscopy under general anaesthesia, to look for any evidence of a primary tumour. Along with PET CT all the patients were also evaluated by MRI also. MRI and PET findings were assessed separately and recorded as “positive” or “negative”, and then correlated with the histological result. Depending on the histological results, the results of the imaging procedures were evaluated as “true-positive”, “false negative”, “true-negative” and “false-negative”. Results: Out of the twenty seven patients, 23(85.19%) had unilateral and rest of the four bilateral cervical lymphadenopathy. FDG-PET-CT was negative in 14 (51.85%) patients and was positive in 13 (48.15%) patients. The sensitivity of PET CT was 87.5% whereas specificity was 89.5%. On MRI total 9 vases were positive for Carcinoma of unknown primary site (CUPS). Out of these 6 cases were also confirmed positive on Histopathological examination. The sensitivity of MRI in diagnosing Carcinoma of unknown primary site (CUPS) was 75% with specificity of 84.21%. The sensitivity of diagnosing the carcinoma of unknown primary site of PET CT was 87.5% whereas that of MRI was 75%. The specificity of PET CT was 89.5% whereas that of MRI was 84.21%. The difference observed in the diagnostic value of PETCT and MRI was statistically not significant. Conclusion: The sensitivity of diagnosing the carcinoma of unknown primary site of PET CT was 87.5% whereas that of MRI was 75%. The difference observed in the diagnostic value of PETCT and MRI was statistically not significant. Thus PET and MRI are characterized by a high sensitivity and specificity and represent important tools in current diagnosis of head and neck tumors.
Authors and Affiliations
S Hari Kumar, Rajesh Kumar Singh, P S Sukthankar, S S Anand
Keywords
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