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Purpose: In this systematic review and individual patient data (IPD) meta-analysis, we analysed the diagnostic performance of [18F]FDG PET/CT in detecting primary tumours in patients with CUP and evaluated whether the location of the predominant metastatic site influences the diagnostic performance. Methods: A systematic literature search from January 2005 to February 2024 was performed to identify articles describing the diagnostic performance of [18F]FDG PET/CT for primary tumour detection in CUP. Individual patient data retrieved from original articles or obtained from corresponding authors were grouped by the predominant metastatic site. The diagnostic performance of [18F]FDG PET/CT in detecting the underlying primary tumour was compared between predominant metastatic sites. Results: A total of 1865 patients from 32 studies were included. The largest subgroup included patients with predominant bone metastases (n = 622), followed by liver (n = 369), lymph node (n = 358), brain (n = 316), peritoneal (n = 70), lung (n = 67), and soft tissue (n = 23) metastases, leaving a small group of other/undefined metastases (n = 40). [18F]FDG PET/CT resulted in pooled detection rates to identify the primary tumour of 0.74 (for patients with predominant brain metastases), 0.54 (liver-predominant), 0.49 (bone-predominant), 0.46 (lung-predominant), 0.38 (peritoneal-predominant), 0.37 (lymph node-predominant), and 0.35 (soft-tissue-predominant). Conclusion: This individual patient data meta-analysis suggests that the ability of [18F]FDG PET/CT to identify the primary tumour in CUP depends on the distribution of metastatic sites. This finding emphasises the need for more tailored diagnostic approaches in different patient populations. In addition, alternative diagnostic tools, such as new PET tracers or whole-body (PET/)MRI, should be investigated. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the added benefit of body MRI (covering the chest, abdomen, and pelvis) to detect the primary tumour in patients with adenocarcinoma of unknown primary (ACUP) and a suspected abdominal malignancy in whom previous diagnostic work-up with CT and/or FDG-PET/CT did not yield a primary tumour diagnosis.Thirty ACUP patients with a suspected primary tumour in the abdomen/pelvis (based on pathology and/or pattern of disease) underwent MRI (T2-weighted, DWI, pre- and post-contrast T1-weighted) after completion of their initial diagnostic work-up with CT and/or PET/CT. Effects of MRI to establish a primary tumour diagnosis (and to detect additional metastatic sites) were documented. Integration of all available imaging data, additional diagnostic procedures (e.g., endoscopy), histopathology, and whole genome sequencing served as the composite standard of reference.MRI rendered a possible primary tumour diagnosis in 16/30 (53%) cases, which aligned with the final clinical diagnosis in 9/16 (56%) of these cases, thus resulting in a confirmed primary tumour diagnosis in 30% of our total patient cohort. These included four gastrointestinal, two hepatobiliary, one pancreatic, one ovarian and one breast cancer. MRI revealed extra metastatic sites in five patients (17%).MRI can be of added value in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, in particular to detect gastrointestinal or hepatobiliary malignancies. Larger studies are needed to confirm these results and identify specific ACUP patients that are most likely to benefit from MRI.QuestionCan body MRI help identify the primary tumour in patients with adenocarcinoma of unknown primary (ACUP)?FindingsIn this pilot of n = 30 ACUP patients with clinically suspected abdominal malignancies, body MRI was able to establish the primary tumour in 30% of cases.Clinical relevanceBody MRI can be of added value (as an adjunct to CT and/or PET/CT) in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, especially to detect gastrointestinal or hepatobiliary malignancies.Methods: This study aimed to evaluate the added benefit of body MRI (covering the chest, abdomen, and pelvis) to detect the primary tumour in patients with adenocarcinoma of unknown primary (ACUP) and a suspected abdominal malignancy in whom previous diagnostic work-up with CT and/or FDG-PET/CT did not yield a primary tumour diagnosis.Thirty ACUP patients with a suspected primary tumour in the abdomen/pelvis (based on pathology and/or pattern of disease) underwent MRI (T2-weighted, DWI, pre- and post-contrast T1-weighted) after completion of their initial diagnostic work-up with CT and/or PET/CT. Effects of MRI to establish a primary tumour diagnosis (and to detect additional metastatic sites) were documented. Integration of all available imaging data, additional diagnostic procedures (e.g., endoscopy), histopathology, and whole genome sequencing served as the composite standard of reference.MRI rendered a possible primary tumour diagnosis in 16/30 (53%) cases, which aligned with the final clinical diagnosis in 9/16 (56%) of these cases, thus resulting in a confirmed primary tumour diagnosis in 30% of our total patient cohort. These included four gastrointestinal, two hepatobiliary, one pancreatic, one ovarian and one breast cancer. MRI revealed extra metastatic sites in five patients (17%).MRI can be of added value in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, in particular to detect gastrointestinal or hepatobiliary malignancies. Larger studies are needed to confirm these results and identify specific ACUP patients that are most likely to benefit from MRI.QuestionCan body MRI help identify the primary tumour in patients with adenocarcinoma of unknown primary (ACUP)?FindingsIn this pilot of n = 30 ACUP patients with clinically suspected abdominal malignancies, body MRI was able to establish the primary tumour in 30% of cases.Clinical relevanceBody MRI can be of added value (as an adjunct to CT and/or PET/CT) in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, especially to detect gastrointestinal or hepatobiliary malignancies.Results: This study aimed to evaluate the added benefit of body MRI (covering the chest, abdomen, and pelvis) to detect the primary tumour in patients with adenocarcinoma of unknown primary (ACUP) and a suspected abdominal malignancy in whom previous diagnostic work-up with CT and/or FDG-PET/CT did not yield a primary tumour diagnosis.Thirty ACUP patients with a suspected primary tumour in the abdomen/pelvis (based on pathology and/or pattern of disease) underwent MRI (T2-weighted, DWI, pre- and post-contrast T1-weighted) after completion of their initial diagnostic work-up with CT and/or PET/CT. Effects of MRI to establish a primary tumour diagnosis (and to detect additional metastatic sites) were documented. Integration of all available imaging data, additional diagnostic procedures (e.g., endoscopy), histopathology, and whole genome sequencing served as the composite standard of reference.MRI rendered a possible primary tumour diagnosis in 16/30 (53%) cases, which aligned with the final clinical diagnosis in 9/16 (56%) of these cases, thus resulting in a confirmed primary tumour diagnosis in 30% of our total patient cohort. These included four gastrointestinal, two hepatobiliary, one pancreatic, one ovarian and one breast cancer. MRI revealed extra metastatic sites in five patients (17%).MRI can be of added value in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, in particular to detect gastrointestinal or hepatobiliary malignancies. Larger studies are needed to confirm these results and identify specific ACUP patients that are most likely to benefit from MRI.QuestionCan body MRI help identify the primary tumour in patients with adenocarcinoma of unknown primary (ACUP)?FindingsIn this pilot of n = 30 ACUP patients with clinically suspected abdominal malignancies, body MRI was able to establish the primary tumour in 30% of cases.Clinical relevanceBody MRI can be of added value (as an adjunct to CT and/or PET/CT) in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, especially to detect gastrointestinal or hepatobiliary malignancies.Conclusion: This study aimed to evaluate the added benefit of body MRI (covering the chest, abdomen, and pelvis) to detect the primary tumour in patients with adenocarcinoma of unknown primary (ACUP) and a suspected abdominal malignancy in whom previous diagnostic work-up with CT and/or FDG-PET/CT did not yield a primary tumour diagnosis.Thirty ACUP patients with a suspected primary tumour in the abdomen/pelvis (based on pathology and/or pattern of disease) underwent MRI (T2-weighted, DWI, pre- and post-contrast T1-weighted) after completion of their initial diagnostic work-up with CT and/or PET/CT. Effects of MRI to establish a primary tumour diagnosis (and to detect additional metastatic sites) were documented. Integration of all available imaging data, additional diagnostic procedures (e.g., endoscopy), histopathology, and whole genome sequencing served as the composite standard of reference.MRI rendered a possible primary tumour diagnosis in 16/30 (53%) cases, which aligned with the final clinical diagnosis in 9/16 (56%) of these cases, thus resulting in a confirmed primary tumour diagnosis in 30% of our total patient cohort. These included four gastrointestinal, two hepatobiliary, one pancreatic, one ovarian and one breast cancer. MRI revealed extra metastatic sites in five patients (17%).MRI can be of added value in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, in particular to detect gastrointestinal or hepatobiliary malignancies. Larger studies are needed to confirm these results and identify specific ACUP patients that are most likely to benefit from MRI.QuestionCan body MRI help identify the primary tumour in patients with adenocarcinoma of unknown primary (ACUP)?FindingsIn this pilot of n = 30 ACUP patients with clinically suspected abdominal malignancies, body MRI was able to establish the primary tumour in 30% of cases.Clinical relevanceBody MRI can be of added value (as an adjunct to CT and/or PET/CT) in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, especially to detect gastrointestinal or hepatobiliary malignancies.Key Points: This study aimed to evaluate the added benefit of body MRI (covering the chest, abdomen, and pelvis) to detect the primary tumour in patients with adenocarcinoma of unknown primary (ACUP) and a suspected abdominal malignancy in whom previous diagnostic work-up with CT and/or FDG-PET/CT did not yield a primary tumour diagnosis.Thirty ACUP patients with a suspected primary tumour in the abdomen/pelvis (based on pathology and/or pattern of disease) underwent MRI (T2-weighted, DWI, pre- and post-contrast T1-weighted) after completion of their initial diagnostic work-up with CT and/or PET/CT. Effects of MRI to establish a primary tumour diagnosis (and to detect additional metastatic sites) were documented. Integration of all available imaging data, additional diagnostic procedures (e.g., endoscopy), histopathology, and whole genome sequencing served as the composite standard of reference.MRI rendered a possible primary tumour diagnosis in 16/30 (53%) cases, which aligned with the final clinical diagnosis in 9/16 (56%) of these cases, thus resulting in a confirmed primary tumour diagnosis in 30% of our total patient cohort. These included four gastrointestinal, two hepatobiliary, one pancreatic, one ovarian and one breast cancer. MRI revealed extra metastatic sites in five patients (17%).MRI can be of added value in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, in particular to detect gastrointestinal or hepatobiliary malignancies. Larger studies are needed to confirm these results and identify specific ACUP patients that are most likely to benefit from MRI.QuestionCan body MRI help identify the primary tumour in patients with adenocarcinoma of unknown primary (ACUP)?FindingsIn this pilot of n = 30 ACUP patients with clinically suspected abdominal malignancies, body MRI was able to establish the primary tumour in 30% of cases.Clinical relevanceBody MRI can be of added value (as an adjunct to CT and/or PET/CT) in the diagnostic work-up of ACUP patients with a suspected primary tumour originating from the abdomen or pelvis, especially to detect gastrointestinal or hepatobiliary malignancies. [ABSTRACT FROM AUTHOR]