Tumor detection with transoral use of flexible endoscopy for unknown primary head and neck cancer

Abstract

Objectives: With the advent of new optical technologies, early pharyngolaryngeal cancerous lesions can be better visualized. Although the conventional transnasal approach offers great views of the hypopharynx and larynx, the visualization of the oropharynx and palatine tonsils is limited. Through the transoral insertion of a flexible video-laryngoscope, direct views of the oropharynx and oral cavity can be obtained.Thus, transoral examination may contribute to primary detection of cancers of unknown primary (CUP).Methods: Eighty-five CUP patients from Tokai University were included retrospectively in this study, from 2006 to 2017. Starting in 2010, we employed the transoral examination in addition to our conventional method. The primary detection rates were compared before and after 2010. Oropharyngeal primaries were further analyzed for tumor subsite and p16 status. Results:The overall primary detection rate did not improve with the addition of transoral examination. However, greater numbers of oropharyngeal primaries were detected. The oropharyngeal lesions detected by transoral examination were mainly p16 positive, located on the palatine tonsil. Conclusion:Transoral examination is a noninvasive, easy method to adopt in an outpatient setting, and a promising technique to improve tumor detection in this era of human papillomavirus-associated head and neck cancers.

Cost‐Effectiveness Analysis of PET‐CT Surveillance After Treatment of Human Papillomavirus‐Positive Oropharyngeal Cancer

“…While clinical practice guidelines recommend physical examination with visual endoscopic evaluation in evaluating patients at risk for HNC, 42 clinical evaluation provides incomplete oropharyngeal visualization and imperfect detection of small or submucosal tumors. [42][43][44] Furthermore, there have been few advancements in clinical examination over time, with narrow-band imaging (NBI) being the only recent innovation. [45][46][47] However, PET/CT scans have repeatedly been demonstrated to detect tumor recurrences, metastases, and second primary cancers earlier than clinical surveillance can, and can even detect tumors missed on clinical examination.…”

“…While our baseline estimate of clinical surveillance sensitivity was 44%, we found that clinical sensitivity must increase to 51% for surveillance PET/CT scans to not be cost‐effective. While clinical practice guidelines recommend physical examination with visual endoscopic evaluation in evaluating patients at risk for HNC, 42 clinical evaluation provides incomplete oropharyngeal visualization and imperfect detection of small or submucosal tumors 42‐44 . Furthermore, there have been few advancements in clinical examination over time, with narrow‐band imaging (NBI) being the only recent innovation 45‐47 .…”

The role of transoral surgery in the diagnosis of the carcinoma of unknown origin of the head and neck

“…Recently, a group in Japan described transoral flexible endoscopy in the clinic for patient with CUP. They found that patients tolerated the procedure well, and that it increased the detection of oropharyngeal primaries, and so this may be a promising additional investigation in future [8 ▪ ].…”

Head and Neck Squamous Cell Carcinoma of Unknown Primary: A Diagnostic Work-Up

“…Ebisumoto et al reported a higher detection rate of oropharyngeal tumors with the combined approach, since the transnasal examination does not always provide sufficient visualization of the oropharynx. 13 …”