Abstract
PurposeTo evaluate the impact of tonsillectomy on the detection of the primary tumor, based on p16 immunohistochemistry analysis, in patients with cervical unknown primary of squamous cell carcinoma (SCC-CUP).MethodsThis was a retrospective study of 63 patients, included from January 2008 to December 2017 in a single institution. All patients had an initial assessment with physical examination, CT scan of the neck and chest, whole body FDG-PET CT, and endoscopy under general anesthesia, which failed to determine the primary tumor.ResultsForty-seven out of the 63 patients had an ipsi- or bilateral tonsillectomy which revealed 12 tonsil cancers (26%). The tonsil primary was ipsilateral to positive nodes in 10 cases, contralateral in 1 case and, in 1 case, the patient had bilateral neck involvement. The analysis of the p16 status was carried out in 41/63 patients (65%). Among the 32 patients who had a p16 analysis and tonsillectomy, the rate of primary detection was 59% (10/17) for p16-postives and 0% (0/15) for p16-negatives (p < 0.001).ConclusionThese results suggest that an extended work-up should be systematically proposed including bilateral tonsillectomy (+/- mucosectomy of the base of tongue) in SCC-CUP p16-positive patients but not in p16-negatives.
Highlights
Pauline Podeur 1, Julien Mancini 2, Jean Delgrande 3, Laure Santini 1, Sebastien Salas 3, Stephanie Wong 4, Antoine Giovanni 1, Patrick Dessi 1, Justin Michel 1, Thomas Radulesco 1 and Nicolas Fakhry 1*
These results suggest that an extended work-up should be systematically proposed including bilateral tonsillectomy (+/- mucosectomy of the base of tongue) in Squamous cell carcinoma (SCC)-Carcinomas of unknown primary (CUP) p16-positive patients but not in p16-negatives
Carcinomas of unknown primary (CUP) of the head and neck are lymph node metastases with no primary tumor identified after a work-up including a physical examination and imaging tests (CT scan of the neck and chest, whole body FDG-PET CT)
Summary
The aim of this study was to evaluate the impact of tonsillectomy on identification of the primary tumor, based on p16 immunohistochemistry analysis, in patients with SCC-CUP
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