Table 30A.2Diagnostic Imaging Recommendations for Patients with Metastases and an Occult Primary*

Presenting Site of Metastatic DiseaseImaging Studies to Consider Initially (chest radiography is always indicated)
Abdominal mass/hepatomegalyAbdominal CT or MRI
Consider barium enema/upper GI series
Biliary tract (painlesss jaundice)Percutaneous and/or endoscopic cholangiopancreatography
Abdominal CT or MRI
Malignant ascitesAbdominal CT or MRI
Consider barium enema/upper GI series
Malignant pleural effusionMammography for women
Consider chest CT
Upper cervical lyph nodesMRI or CT of upper airways if endoscopy is negative
Consider thyroid scan
Lower cervical lymph nodesCT of chest/abdomen
Condsider mammography in women
Axillary lymph nodes (undifferentiated cancer)Mammography in women
Consider chest CT
Brain (diagnosed on CT or MRI)Chest CT (if radiographs are nondiagnostic)
Spinal epidural space (on myelogram, contrast CT, or MRI)Chest CT (if radiographs are nondiagnostic)
BoneRadionuclide bone scan survey, with correlative radiographs of selected areas
CT of chest/abdomen (if chest radiographs are nondiagnostic)
Consider ultrasound of prostate (men) or mammography (women)
Lungs (multiple nodules)CT or MRI of abdomen/pelvis
Consider barium enema/upper GI

CT = computed tomography; MRI = magnetic resonance imaging; GI = gastrointestinal.


Adapted with permission from Kagan and Steckel.23

While still under investigation, a total body PET scan with FDG might also be considered for any of these clinical presentations.

From: Chapter 30A, Imaging Cancer of Unknown Primary Site

Cover of Holland-Frei Cancer Medicine
Holland-Frei Cancer Medicine. 5th edition.
Bast RC Jr, Kufe DW, Pollock RE, et al., editors.
Hamilton (ON): BC Decker; 2000.
© 2000, BC Decker Inc.

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