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18F-FDG PET/CT for detection of the primary tumor in adults with extracervical metastases from cancer of unknown primary: A systematic review and meta-analysis.

Abstract Cancer of unknown primary (CUP) is a heterogeneous group of cancers, so called when a biopsy from a patient reveals malignancy without giving a clue to where in the body the primary tumor is located. Whole-body 18-fluorine-fluorodeoxyglucose positron-emission-tomography/computed tomography (18F-FDG PET/CT) is widely used for diagnosis and staging of most cancers. We hypothesized that 18F-FDG PET/CT-especially if used early-is suitable for the detection of the primary tumor in patients with CUP.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28422888
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - 18F-FDG PET/CT for detection of the primary tumor in adults with extracervical
      metastases from cancer of unknown primary: A systematic review and meta-analysis.
PG  - e6713
LID - 10.1097/MD.0000000000006713 [doi]
AB  - BACKGROUND: Cancer of unknown primary (CUP) is a heterogeneous group of cancers, 
      so called when a biopsy from a patient reveals malignancy without giving a clue
      to where in the body the primary tumor is located. Whole-body
      18-fluorine-fluorodeoxyglucose positron-emission-tomography/computed tomography
      (18F-FDG PET/CT) is widely used for diagnosis and staging of most cancers. We
      hypothesized that 18F-FDG PET/CT-especially if used early-is suitable for the
      detection of the primary tumor in patients with CUP. OBJECTIVE: To assess the
      ability of 18F-FDG PET/CT to detect the primary tumor in adult CUP patients. DATA
      SOURCES: PubMed/Medline, Embase, and Web of Science. STUDY ELIGIBILITY CRITERIA: 
      Studies on CUP from extracervical metastases in which every patient had received 
      an 18F-FDG PET/CT scan and at least one 18F-FDG PET/CT-positive finding was
      confirmed by biopsy or clinical follow-up. STUDY APPRAISAL: PRISMA and QUADAS-2
      were applied. SYNTHESIS METHODS: The pooled detection rate (DR) of 18F-FDG PET/CT
      was assessed with a fixed-effects model. Heterogeneity among studies was assessed
      with the I-squared statistic. RESULTS: A total of 2953 articles were identified
      from which N = 82 were assessed by full text and N = 20, comprising 1942 adult
      patients, were included in the study. Median (range) number of patients and DR
      was N = 72 (21-316) and 36.3% (9.8%-75.3%), respectively. Two-thirds of included 
      studies were retrospective, and the pooled DR was 40.93% (95% confidence
      interval: 38.99%-42.87%). There was large heterogeneity between studies
      (I-squared = 95.9%), randomization was not applied, CUP diagnosis was not
      standardized, and workup (if described) was characterized by multiple testing
      procedures resulting in a highly selected, challenging patient group.
      CONCLUSIONS: Despite great heterogeneity in diagnostic workup and in studies in
      general, an overall DR of 40.93% suggests that upfront application of 18F-FDG
      PET/CT may have a role in CUP by obviating a great many futile diagnostic
      procedures. To what degree 18F-FDG PET/CT used early in the course of disease may
      improve the detection rate could not be deducted from selected articles. A large,
      prospective, preferably randomized, study on the potential benefit of using
      18F-FDG PET/CT up front in CUP patients is warranted to judge if and when 18F-FDG
      PET/CT should be applied in these patients.
FAU - Burglin, Synne Alexandra
AU  - Burglin SA
AD  - aDepartment of Nuclear Medicine, Odense University Hospital bDepartment of
      Clinical Research, University of Southern Denmark, Odense C cDepartment of
      Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg dCentre of
      Health Economics Research, University of Southern Denmark, Odense M, Denmark.
FAU - Hess, Soren
AU  - Hess S
FAU - Hoilund-Carlsen, Poul Flemming
AU  - Hoilund-Carlsen PF
FAU - Gerke, Oke
AU  - Gerke O
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006713 [doi]
AID - 00005792-201704210-00070 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6713. doi: 10.1097/MD.0000000000006713.

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