Abstract
Diagnostic rates of unknown primary head and neck carcinoma (UPHNC) using lingual tonsillectomy (LT) are highly variable. This study sought to determine the diagnostic value of LT in UPHNC identification using strict inclusion criteria and definitions to produce a more accurate estimate of diagnosis rate. In this retrospective chart review, records of patients who underwent LT for UPHNC were reviewed. Inclusion criteria included absence of suspicious findings on physical exam and positron emission tomography-computed tomography as well as negative biopsies after panendoscopy and palatine tonsillectomy. Following inclusion criteria, 16 patients were reviewed. A systematic literature review on LT for the workup of CUP was also performed. LT was performed using transoral robotic surgery (TORS), transoral laser microsurgery (TLM), or transoral microsurgery with cautery (TMC). Following LT, primary tumor was identified in 4 patients out of 16. Detection rate by technique was 1/6, 2/7, and 1/3 for TORS, TLM, and TMC respectively. Postoperative bleeding occurred in three patients (19%); however, this was not related to the LT. Following literature review, 12 studies were identified; however, only 3 had enough data to compare against. All three studies had a cohort with suspicious findings on clinical exam. A total of 34 patients had a negative workup, with no suspicious findings on clinical exam and subsequently received an LT. This study suggests that LT should be considered initially in the diagnostic algorithm for UPHNC. This study can increase the patient size in this cohort by approximately 47%.
Highlights
Unknown primary head and neck carcinoma (UPHNC) presents as metastatic malignancy identified in a cervical lymph node without identification of primary origin on diagnostic examination [1, 2]
We reviewed the medical records of all patients presenting between February 2010 and May 2017 who had undergone lingual tonsillectomy (LT) and biopsy-proven metastatic squamous cell carcinoma (SCC) to cervical lymph nodes without an identified primary site
Identification of the site of origin for unknown primary SCC is an essential goal for the head and neck surgeon
Summary
Unknown primary head and neck carcinoma (UPHNC) presents as metastatic malignancy identified in a cervical lymph node without identification of primary origin on diagnostic examination [1, 2]. Representing approximately 2–5% of all new head and neck malignancies, the primary site is eventually isolated to the palatine or lingual tonsils in 80–90% of patients [5, 6]. Panendoscopy with tumor mapping is performed, with or without palatine tonsillectomy. Reported diagnostic rates of tumor mapping are approximately 20–50% when biopsies can be targeted with PET-CT; diagnostic rates markedly decrease to 9–29% when PET-CT is negative [5, 6, 9, 10]
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