tailieunhanh - Chapter 095. Carcinoma of Unknown Primary (Part 2)

Role of Imaging Studies Chest x-rays are always obtained in CUP workups but are often negative, especially with low-volume disease. CT scans of the chest, abdomen, and pelvis can be used to help find the primary, evaluate the extent of disease, and select the most favorable biopsy site. Older studies suggested that the primary tumor site is detected in 20–35% of patients who undergo a CT scan of the abdomen and pelvis, although by current definition these patients would not be considered as having CUP. . | Chapter 095. Carcinoma of Unknown Primary Part 2 Role of Imaging Studies Chest x-rays are always obtained in CUP workups but are often negative especially with low-volume disease. CT scans of the chest abdomen and pelvis can be used to help find the primary evaluate the extent of disease and select the most favorable biopsy site. Older studies suggested that the primary tumor site is detected in 20-35 of patients who undergo a CT scan of the abdomen and pelvis although by current definition these patients would not be considered as having CUP. Older studies also suggest a latent primary tumor prevalence of 20 with more sophisticated imaging this prevalence is 10 today. Mammography should be performed in all women who present with metastatic adenocarcinoma especially in those with adenocarcinoma and isolated axillary adenopathy. MRI of the breast is a recognized follow-up modality in patients with suspected occult primary breast carcinoma following negative mammography and sonography findings . The results of these imaging modalities can influence surgical management a negative breast MRI result predicts a low tumor yield at mastectomy. A conventional workup for a cervical CUP neck lymphadenopathy with no known primary tumor includes a CT scan or MRI and invasive studies including indirect and direct laryngoscopy bronchoscopy and upper endoscopy. Ipsilateral or bilateral tonsillectomy with histopathology has been recommended for cervical CUP patients. 18 F-fluorodeoxyglucose FDG positron emission tomography PET scans are useful in this patient population and may help guide the biopsy determine the extent of disease facilitate the appropriate treatment including planning radiation fields and help with disease surveillance. Several studies have evaluated the utility of PET in patients with cervical CUP. These trials have included a small number of patients primary tumors were identified in 21-30 . The diagnostic contribution of PET to the evaluation of noncervical CUP