TY - JOUR
T1 - International consensus on the initial diagnostic workup of cancer of unknown primary
AU - van der Strate, Iris
AU - Kazemzadeh, Fatemeh
AU - Nagtegaal, Iris D.
AU - Robbrecht, Debbie
AU - van de Wouw, Agnes
AU - Padilla, Catarina S.
AU - Duijts, Saskia
AU - Esteller, Manel
AU - Greco, F. Anthony
AU - Pavlidis, Nicholas
AU - Qaseem, Amir
AU - Snaebjornsson, Petur
AU - van Zanten, Sophie Veldhuijzen
AU - Loef, Caroline
N1 - Funding Information: We would like to offer our special thanks to all the panelists for their contribution in the Delphi Study. Without their contribution and their valuable knowledge on CUP we would not have been able to conduct this study. Publisher Copyright: © 2022 Elsevier B.V.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Although the incidence of Cancer of Unknown Primary (CUP) is estimated to be 1–2 % of all cancers worldwide, no international standards for diagnostic workup are yet established. Such an international guideline would facilitate international comparison, provide adequate incidence and survival rates, and ultimately improve care of patients with CUP. Methods: Participants for a four round modified Delphi study were selected via a CUP literature search in PubMed and an international network of cancer researchers. A total of 90 CUP experts were invited, and 34 experts from 15 countries over four continents completed all Delphi survey rounds. Findings: The Delphi procedure resulted in a multi-layer CUP classification for the diagnostic workup. Initial diagnostic workup should at least consist of history and physical examination, full blood count, analysis of serum markers, a biopsy of the most accessible lesion, a CT scan of chest/abdomen/pelvis, and immunohistochemical testing. Additionally, the expert panel agreed on the need of an ideal diagnostic lead time for CUP patients. There was no full consensus on the place in diagnostic workup of symptom-guided MRI or ultrasound, a PET/CT scan, targeted gene panels, immunohistochemical markers, and whole genome sequencing. Interpretation: Consensus was reached on the contents of the first diagnostic layer of a multi-layer CUP classification. This is a first step towards full consensus on CUP diagnostics, that should also include supplementary and advanced diagnostics.
AB - Background: Although the incidence of Cancer of Unknown Primary (CUP) is estimated to be 1–2 % of all cancers worldwide, no international standards for diagnostic workup are yet established. Such an international guideline would facilitate international comparison, provide adequate incidence and survival rates, and ultimately improve care of patients with CUP. Methods: Participants for a four round modified Delphi study were selected via a CUP literature search in PubMed and an international network of cancer researchers. A total of 90 CUP experts were invited, and 34 experts from 15 countries over four continents completed all Delphi survey rounds. Findings: The Delphi procedure resulted in a multi-layer CUP classification for the diagnostic workup. Initial diagnostic workup should at least consist of history and physical examination, full blood count, analysis of serum markers, a biopsy of the most accessible lesion, a CT scan of chest/abdomen/pelvis, and immunohistochemical testing. Additionally, the expert panel agreed on the need of an ideal diagnostic lead time for CUP patients. There was no full consensus on the place in diagnostic workup of symptom-guided MRI or ultrasound, a PET/CT scan, targeted gene panels, immunohistochemical markers, and whole genome sequencing. Interpretation: Consensus was reached on the contents of the first diagnostic layer of a multi-layer CUP classification. This is a first step towards full consensus on CUP diagnostics, that should also include supplementary and advanced diagnostics.
KW - CUP
KW - Cancer of unknown primary
KW - Consensus
KW - Delphi study
KW - Diagnostics
KW - International
UR - http://www.scopus.com/inward/record.url?scp=85142714311&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.critrevonc.2022.103868
DO - https://doi.org/10.1016/j.critrevonc.2022.103868
M3 - Review article
C2 - 36435296
SN - 1040-8428
VL - 181
JO - Critical Reviews in Oncology/Hematology
JF - Critical Reviews in Oncology/Hematology
M1 - 103868
ER -