Learning objectives
Definition and diagnostic work-up of carcinoma of unknown primary (CUP)
To determinethe roleofPET CT in investigating cases of CUP
To outline specific indications for performing PET CT in the setting of CUP to aidwith patient selection
Background
Definition and epidemiology
Carcinoma of unknown primary (CUP) represents a heterogeneous group of metastatic malignancies for which no primary tumour site can be identified after diagnostic work-up.
'Provisional CUP' is defined as patients with metastatic malignancy of proven epithelial,
neuro-endocrine or undifferentiated lineage after initial but not exhaustive investigations.
'Confirmed CUP' can be diagnosed after all investigations are complete.
In contrast,
malignancy of undefined primary Origin (MUO) is a patient who presents with suspected metastatic malignancy,
identified on clinical examination or by imaging,
without an...
Findings and procedure details
Methodology
We collected data onthe utilisation of PET-CT in a regional CUP MDT duringa one year period in 2017.
A retrospective review of all cases in whichPET-CT was performed at the request of the MDT.
In particular,
we evaluated the questions being asked by the MDT and whether PET-CT was successfulin answering them.
Results
A total of 204 patientswere referred for discussion at the CUP MDT over the one year period.
20 PET-CTs were requested by the MDT and all were subsequently performed.
Thequestions proposed...
Conclusion
Conclusions:
PET-CT is useful in the setting of CUP in carefully selected patientsfollowingMDT discussion.The role of PET-CTmay include one or more of the following:
Finding theprimary
Guiding the biopsy site
Functional imaging-based tissue characterisation
Prognostic categorisation -identifying oligometastatic disease and/or favourable subsets
However,
PET-CT should only beconsidered if it will affect management decisions and the patient is fit for treatment.
Personal information
Contact details:
Dr Radhakrishnan Jayan
Consultant Radiologist,
Departmenr of Radiology,
Royal Liverpool University Hospital.
Prescot Street,
Liverpool,
U.K,
L7 8XP.
Email:
[email protected]
Dr.Lizzie O'Mahony
ST3 Radiology Registrar,
Department of Radiology,
Royal Liverpool University Hospital.
Prescot Street,Liverpool,
U.K,
L7 8XP.
Email:
[email protected]
References
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[No date].
Cancer of unknown primary statistics. [Online].
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2National institute for Heath and Care Excellence.
2010.
Metastatic malignant disease of unknown primary origin in adults: diagnosis and management.
[CG104].
[Online].
London: National institute for Heath and Care Excellence.
[Accessed December 2018].
Available from: https://www.nice.org.uk/guidance/cg104/chapter/1-Guidance#diagnosis.
3Ettinger DS,
Agulnik M,
Cates JM,
et al.
NCCN clinical practice guidelines in oncology: occult primary.
J Natl Compr Cancer Netw.
2011;9:1358-95.
4Cetin Avci N,
Hatipoglu F,
Alacacaioglu A,
Bayar EE,
Bural...