Metastatic Carcinoma of the Neck of Unknown Primary Origin: Evolution and Efficacy of the Modern Workup

Abstract

Diagnostic workup including PET-CT, alongside panendoscopy with directed biopsies including bilateral tonsillectomy, offers the greatest likelihood of successfully identifying occult primary tumor location.

Prognostic Relevance of 18F-FDG PET/CT in Carcinoma of Unknown Primary

“…25,26 In contrast with our data on the sensitivity, specificity, positive predictive value, and negative predictive value of 18 F-FDG PET/CT, our results are at the upper end of what has been reported, 5 and our false-positive rate was lower than that in most studies in literature. 25,26 In contrast with our data on the sensitivity, specificity, positive predictive value, and negative predictive value of 18 F-FDG PET/CT, our results are at the upper end of what has been reported, 5 and our false-positive rate was lower than that in most studies in literature.…”

Outcomes of HPV + Oropharyngeal Carcinoma of Unknown Primary Following Transoral Robotic Surgery

“…In this study, a mucosal primary was identified in 88% of patients. This is similar to previously reported detection rates ranging from 75% to 90% using TORS in smaller cohorts [11,[25][26][27][28], and importantly continues to surpass the pre-TORS era work-up of using anatomic imaging +/-PET-CT and surgical endoscopy with primary identification rates in the range of 40%-60% [7,8]. While the traditional therapy of total mucosal concurrent chemoradiation has excellent oncologic outcomes (2-year OS 92%), significant rates of grade 3+ acute and late treatment toxicities including dysphagia, esophageal strictures, and other toxicities causing increased treatment-related hospitalizations and mortality (estimated at 2% from chemoradiation to head and neck) continue to be motivating factors to de-escalate adjuvant therapy [29][30][31].…”

Transoral laser microsurgery for the unknown primary: Role for lingual tonsillectomy

“…If no tumor is found, we proceed with palatine tonsillectomies, followed by a lingual tonsillectomy encompassing lingual tonsil tissue past midline or bilateral lingual tonsillectomies. Without TLM techniques, our yield of finding occult tumors was 50% (8 of 16), a rate comparable to previously reported series . But with TLM and a laser‐assisted lingual tonsillectomy, our detection rate was 86.1% (31 of 36).…”