{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T10:57:01Z","timestamp":1776164221197,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T00:00:00Z","timestamp":1472688000000},"content-version":"vor","delay-in-days":5844,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2000,9]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>The neck lymph nodes are a common site of metastases from carcinoma of unknown primary (CUP syndrome). 2[<jats:sup>18<\/jats:sup>F]\u2010fluoro\u20102\u2010deoxy\u2010D\u2010glucose positron emission tomography (18\u2010FDG\u2010PET) has been shown to be a sensitive tool for detecting primary malignant lesions as well as metastatic spread. We have prospectively investigated the sensitivity of 18\u2010FDG\u2010PET in detecting occult primary carcinomas with manifestation in the head and neck lymph nodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>From May 1994 to July 1998, in 723 patients a cancer of the head and neck was diagnosed at the University of Cologne ENT outpatient clinic. The routinely performed staging procedures were chest radiography; full blood count; cervical and liver ultrasound; endoscopy of the nasopharynx, oropharynx, hypopharynx, larynx, and esophagus; and laboratory analyses. After the staging workup, in 27 of 723 patients (3.7%) CUP syndrome had to be presumed because the primary cancer could not be detected. In these patients 18\u2010FDG\u2010PET was performed, and images were reconstructed with a transmission\u2010emission fusion technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In 7 of 27 patients (26%) 18\u2010FDG\u2010PET revealed an unknown primary: in 2 a bronchial carcinoma, in 2 a nasopharyngeal carcinoma, in 1 a squamous cell carcinoma of the parotid gland, in 1 a squamous cell carcinoma of the hypopharynx, and in 1 a carcinoma of the tonsil. In 4 of 7 patients the occult primary tumor was removed surgically. In 8 of 27 patients therapeutic strategy was changed as a result of the 18\u2010FDG\u2010PET findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>18\u2010FDG\u2010PET should be performed in all patients with CUP syndrome after conventional diagnostic workup fails to identify the primary.<\/jats:p><\/jats:sec>","DOI":"10.1067\/mhn.2000.104807","type":"journal-article","created":{"date-parts":[[2003,2,4]],"date-time":"2003-02-04T21:49:09Z","timestamp":1044395349000},"page":"294-301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":122,"title":["2[<sup>18<\/sup>F]\u2010Fluoro\u20102\u2010Deoxy\u2010D\u2010Glucose Positron Emission Tomography is a Sensitive Tool for the Detection of Occult Primary Cancer (Carcinoma of Unknown Primary Syndrome) with Head and Neck Lymph Node Manifestation"],"prefix":"10.1002","volume":"123","author":[{"given":"Markus","family":"Jungehulsing","sequence":"first","affiliation":[{"name":"ENT Department University of aCologne Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klemens","family":"Scheidhauer","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Department University of aCologne Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Damm","sequence":"additional","affiliation":[{"name":"ENT Department University of aCologne Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Pietrzyk","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Neurologic Research Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Eckel","sequence":"additional","affiliation":[{"name":"ENT Department University of aCologne Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harald","family":"Schicha","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Department University of aCologne Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eberhard","family":"Stennert","sequence":"additional","affiliation":[{"name":"ENT Department University of aCologne Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1994.12.6.1272"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19950101)75:1 <353::AID-CNCR2820751317>3.0.CO;2-P"},{"key":"e_1_2_12_4_1","first-page":"573","article-title":"Diagnosis and therapy of occult primary tumor with lymph node metastases in the area of the head and neck [in German]","volume":"45","author":"Jungeh\u00fclsing M","year":"1997","journal-title":"HNO"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(1950)3:1<74::AID-CNCR2820030111>3.0.CO;2-7"},{"key":"e_1_2_12_6_1","first-page":"206","article-title":"Pathological evaluation of neoplasms with unknown primary tumor site","volume":"20","author":"Mackay B","year":"1993","journal-title":"Semin Oncol"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1995.13.8.2094"},{"key":"e_1_2_12_8_1","first-page":"299","article-title":"Halsymphknotenmetastasen bei unbekanntem Primartumor. Verlaufsbeobachtung an 58\u00a0Patienten [Cervical lymph node metastases in unknown primary tumor. Follow\u2010up of 58 patients]","volume":"43","author":"Subramanian R","year":"1995","journal-title":"HNO"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/07853899708999347"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0969-8051(94)90045-0"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ssu.2980070104"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(05)80562-8"},{"key":"e_1_2_12_13_1","first-page":"235","article-title":"Efficient stereospecific synthesis of non\u2010carrier\u2010added 2\u2010[18F]\u2010fluoro\u20102\u2010deoxy\u2010D\u2010glucose using aminopolyether supported nucleophilic substitution","volume":"27","author":"Hamacher K","year":"1986","journal-title":"J Nucl Med"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0720-048X(95)00713-Z"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/019459988910000301"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.169.6.9393187"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199203000-00010"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.186.1.8416578"},{"key":"e_1_2_12_19_1","first-page":"211","article-title":"Detection of lymph node metastases of squamous cell cancer of the head and neck with FDG\u2010PET and MRI","volume":"36","author":"Braams JW","year":"1995","journal-title":"J Nucl Med"},{"key":"e_1_2_12_20_1","first-page":"353","article-title":"Can positron emission tomography distinguish tumor recurrence from irradiation sequelae in patients treated for larynx cancer?","volume":"3","author":"Greven KM","year":"1997","journal-title":"Cancer J Sci Am"},{"key":"e_1_2_12_21_1","first-page":"296","article-title":"Positron emission tomography (PET) in the evaluation of tumor proliferation and follow\u2010up of therapy in ear, nose and throat tumors [in German]","volume":"32","author":"Haberkorn U","year":"1992","journal-title":"Radiologe"},{"key":"e_1_2_12_22_1","first-page":"496","article-title":"Basic principles of positron emission tomography in oncology: Quantitation and whole body techniques","volume":"106","author":"Hoh CK","year":"1994","journal-title":"Wien Klin Wochenschr"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.179.3.2027989"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0901-5027(05)80829-X"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19980315)82:6<1160::AID-CNCR22>3.0.CO;2-3"},{"key":"e_1_2_12_26_1","first-page":"254","article-title":"Positron emission tomography for primary tumor detection in lymph node metastases with unknown primary tumor [in German]","volume":"44","author":"Schipper JH","year":"1996","journal-title":"HNO"},{"key":"e_1_2_12_27_1","first-page":"157","article-title":"An effective strategy for the evaluation of unknown primary tumors","volume":"41","author":"Abbruzzese JL","year":"1988","journal-title":"Cancer Bull"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1990.01870120034004"},{"key":"e_1_2_12_29_1","first-page":"238","article-title":"The biology of unknown primary tumors","volume":"20","author":"Abbuzzese JL","year":"1993","journal-title":"Semin Oncol"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)92040-M"},{"key":"e_1_2_12_31_1","first-page":"233","article-title":"Unknown primary tumors: An example of accelerated (type 2) tumor progression","volume":"57","author":"Frost P.","year":"1991","journal-title":"Basic Life Sci"},{"key":"e_1_2_12_32_1","first-page":"104","article-title":"Gibt es die malignisierte laterale Halszyste doch? [Does malignant lateral cervical cyst still exist?]","volume":"43","author":"Knobber D","year":"1995","journal-title":"HNO"},{"key":"e_1_2_12_33_1","first-page":"644","article-title":"Cancer in the neck without obvious source","volume":"53","author":"Devine Kd.","year":"1978","journal-title":"Mayo Clin Proc"},{"key":"e_1_2_12_34_1","first-page":"988","article-title":"Metastatic carcinoma in cervical lymph nodes from occult primary sites. A review","volume":"64","author":"Ridenhour CE","year":"1967","journal-title":"Mo Med"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19980315)82:6<1160::AID-CNCR22>3.0.CO;2-3"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.203.2.9114082"},{"key":"e_1_2_12_37_1","first-page":"1776","article-title":"Detection of scalene lymph node metastases from lung cancer","volume":"107","author":"Scott WJ","year":"1995","journal-title":"Positron emission tomography published erratum appears in Chest"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1067\/mhn.2000.104807","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1067\/mhn.2000.104807","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1067\/mhn.2000.104807","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T08:48:04Z","timestamp":1760950084000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1067\/mhn.2000.104807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,9]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2000,9]]}},"alternative-id":["10.1067\/mhn.2000.104807"],"URL":"https:\/\/doi.org\/10.1067\/mhn.2000.104807","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,9]]},"assertion":[{"value":"2016-09-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}