Primeri bilinmeyen kanserlerde primer odak tespitinde PET/BT' nin etkinliği

Amaç : Çalışmanın amacı primeri bilinmeyen karsinom tanısı almış hastalarda primer odak saptamada PET/BTnin etkinliğinin saptanması dır. Gereç ve Yöntem: Çalışmaya primeri bilinmeyen karsinom tanısı almış ve sonrasında primer odak tespiti amacıyla PET/BT çekimi yapılmış 51 hasta dahil edildi. Görüntülemede artmış FDG uptakei gösteren bölgeler görsel ve semikantitatif analizle değerlendirildi. Bulg ular: Hastaların açlık kan glukoz seviyeleri 82 ile 149 mg/dl (ortalama 105.14) arasındaydı. SUVmax değerleri 0 ile 17.50 (ortalam a 8.126) olarak hesaplandı. Hastaların 23ünde (%45.1) adenokarsinoma, 16sında (%31.4) karsinoma, 4ünde (%7.8) malign epit elyal tumor, 3ünde (%5.9) küçük hücreli dışı akciğer kanseri 2sinde (%3.9) skuamöz hücreli karsinoma, birer hastada ise (%2) küçük hücreli akciğer kan seri, iğsi hücreli karsinoma ve böbrek hücreli karsinoma histopatolojik olarak saptandı. Görüntüleme son ucunda 13 hastada (%25.5) primer odak saptanamadı. Hastaların 15inde (%29.4) akciğer, 8inde (%15.7) kolon, 5inde (%9.8) pankreas, 3ünde (%5.9) karaciğer, 2sinde (%3.9) mid e, birer hastada ise (%2) plevra, uterus, böbrek, nazofarinx ve primer peritonea l karsinom tespit edildi. Sonuç: Sonuçta PET/BT 51 hastanın 38inde (%72.5) primer odağı ortaya koymuştur. Biz primeri bilinmeyen karsinomlu hastalarda primer odağın ortaya konmasında PET/BT görüntülemenin umut vaat ettiği düşüncesindeyiz.

PET/CT efficacy in determination of primary focus in carcinoma of unknown primary

Objective: The aim of this study is to define primary focus detection efficiency of PET/CT in patients with carcinoma of unknown primary. Material and Method : Fifty one patients- who diagnosed with carcinoma of unknown primary detected with PET/CT to define the primary focus - were included in this study. Increased F -18 FDG foci were evaluated by visual and semiquan titative analysis. Results: Fasting blood glucose levels were between 82 and 149 mg/dl(average 105.14). SUVmax values calculated from 0 to 17.50 (average 8.126). In 23 patients (%45.1) adenocarcinoma, 16 patients (%31.4) carcinoma, 4 patients (%7.8) maligna nt epitelial tumor, 3 patients (%5.9) non small cell carcinoma, 2 patients (%3.9),squamous cell carcinoma, 1 patient (%2) small cell carcinoma,1 patient spindle cell carcinoma an d 1 patient renal cell carcinoma were detected histopathologically. In 13 patients (%25.5) there was no evidence of primary focus, 15 patients (%29.4) lung, 8 patients (%15.7) colon, 5 patients (%9.8) pancreas, 3 patients (%5.9) liver, 2 patients (%3.9) stomach, 1 patient (%2) pleura, 1 patie nt (%2) uterus, 1 patient (%2) kidney, 1 patient (%2) nasopharnyx and 1 patient (%2) primary peritoneal lesion has detected as primary according to PET/CT results. Conclusion: As a result, PET/CT has been identified the primary focus in 38/51 (%72.5) patients. We think PET/CT has a promising futu re in patients with carcinoma of unknown primary to determine the primary focus.

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1. Abell TL, Riely CA. Hyperemesis gravidarum. Gastroenterol Clin North Am 1992; 21: 835 -49.
2. Pavlidis N, Pentheroudakis G. Cancer of unknown primary site. La ncet 2012; 379: 1428 -35.
3. Pentheroudakis G, Briasoulis E, Pavlidis N. Cancer of unknown primary site: missing primary or missing biology? The Oncologist 2007; 12: 418 -25.
4. Pentheroudakis G, Golfinopoulos V, Pavlidis N. Switching benchmarks in cancer of unknown primary: from autopsy to microarray Eur J Cancer 2007; 43: 2026 -36.
5. Abbruzzese JL, Abbruzzese MC, Lenzi R, et al. MN: Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin. J Clin Oncol 1995; 13: 2094 -103.
6. Pentheroudakis G, Greco FA, Pavlidis N. Molecular assignment of tissue of o rigin in cancer of unknown primary may not predict response to therapy or outcome: A systematic literature review. CancerTreat Rev 2009; 35: 221 -7.
7. Jong SP , Yim J, Kang WJ, et al. Detection of p rimary sites in unknown primary tumors using FDG -PET or FDG- PET/CT BMC Research Notes 2011; 4: 56.
8. Pavlidis N, Fizazi K. Carcinoma of unknown primary. Clinical reviews in Oncology/Hematology 2009; 69 : 271 -8.
9. Lazaridis G, Pentheroudakis G, Fountzilas G, et al. Liver metastases from cancer of unknown primary (CUPL): A retrospective analysis of presentation, management and prognosis in 49 patients and systematic review of the literature Cancer Treatment Reviews 2008; 34: 693 - 700 .
10. Pouesse D, Thezenas S, Culine S , et al. Hepatic metastases from carcinomas of unknown primary site : Experience of the montpellier cancer center. Gastroenterol Clin Biol 2005; 29: 1224 -32.
11. Sikorska HM, Fuks A, Gold P. Carcinoemryonic antigen In: Sell Sed. Serological ca ncer markers. Totowa NJ: Humana Pres 1992; 47 -97.
12. Karsell PR, Sheedy PF, OConnel MJ. Computed tomography in search of cancer of unknown origin. JAMA 1982; 248: 340- 3.
13. Hu M, Zhao W, Zhang P , et al. Clinical applications of 18F - fluorodeoxyglucose positron e mission tomography/computed tomography in carcinoma of unknown primary Chin Med J 2011 ; 124: 1010-4.
14. Fencl P, Belohlavek O, Skopalova M , et al. Prognostic and diagnostic accuracy of 18F -FDG PET/CT in 190 patient with carcinoma of unknown primary. Eur J Nuc l Med Mol İmaging 2007; 34: 1783 -92.
15. Pelosi E, Pennone M, Deandreis D, et al. Role of whole body positron emission tomography/computed tomography scan with 18F - fluorodeoxyglucose in patients with biopsy proven tumor metastases from unknown primary site Q. J Nucl Med Mol Imaging 2006 ; 50: 15 -2.
16. Kwee TC, Kwee RM. Combined FDG -PET/CT for the detection of unknown primary tumors:systematic review and meta -analysis. Eur Radiol 2009 ; 19: 731 -44.