Tongue Base Resection in Workup of Unknown Primary Head and Neck Cancer

Abstract

Objective: Often, extensive workup (H&P, CT/MRI/FDG-PET, tonsillectomy and biopsies) is undertaken to detect the primary tumor of a cervical metastasis, in order to reduce morbidity of treatment. We report on transoral resection of the base of tongue (at the time of panendoscopy) in the diagnostic management of unknown primary HN cancers. Method: In this retrospective study, we reviewed findings from workups of Loma Linda University patients with unknown primary HN cancer in the past 4 years (when base of tongue resection was instituted) and noted the number of primary unknowns detected by base of tongue resection vs traditional diagnostic modalities. Results: In the past 4 years, 17 patients underwent panendoscopy for the diagnosis of an unknown primary cancer after careful outpatient workup, including CT/PET studies, failed to reveal a source. Of this group, a primary source was found in eight by tonsillectomy and directed biopsies. In the remaining 9, transoral laser resection of the ipsilateral base of tongue was performed, and a base of tongue source was found in 4. In all of these, no lesion was visualized or palpable, there were no procedure complications, patients returned to adequate PO intake immediately and operative time increased by forty minutes on average. Conclusion: We conclude that transoral laser resection of the base of tongue in the workup of unknown primary HN cancers is safe, is well-tolerated, and provides valuable information for therapeutic planning as a supplement to other traditional diagnostic modalities, when no primary source has been previously identified.