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Aim of work: To evaluate the significance of PET/CT in detection of the primary of metastases of unknown origin and its role in changing management. Patients and methods: A prospective analysis of 123 patients, with pathologically proved or clinico-radio logically suspected metastatic lesions of unidentified primary. All patients had previous examination and investigational check-up tests including labs, radiologic studies and histopathology before undergoing 18FDG PET/CT study, with a follow-up period of 12 months. Results: This study included 66 males and 57 females with mean age 53.98±12.9 (range=23-85) years. Main sites of presenting metastases were bone (29%) and lymph nodes (22%) followed by liver (17%) and brain (11%). Histopathology revealed poorly differentiated carcinomain 42% of patients; however, 27% of patients came with no pathology. PET/CT identified the primary site in 71 patients with commonest site in 16 patients in lung followed by pancreas and breast (9 patients each). False positive was evident in 6 patients, and it excluded malignancy in 19 patients. False negative results were found in 27 studies, 24 of which remained unknown till the end of follow-up period. Sensitivity, specificity, PPV, NPV and accuracy were 72%, 76%, and 79%, 41% and 73% respectively. PET/CT identified additional sites of metastases in 64 patients. PET/CT altered the management in 90 patients by avoiding unnecessary chemotherapy in negative patients or providing treatment targeting known primary tumor, including surgery with curative intent in 9% of patients. During the follow-up period of the 71 patients, 12 patients achieved complete response, 12 patients showed partial response and 25 patients had stable disease. Conclusion: 18F-FDG PET/CT is additiveimaging modality that help in early detection of the primary malignant site in patients with MUO and so enabling selection of suitable management protocols that might improve patients' outcome.

Impact of 18F-FDG-PET/CT in detection of the primary site and change management in patients with metastases of unknown primary.