Open AccessTranscervical Ultrasound Identifies Primary Tumor Site of Unknown Primary Head and Neck Squamous Cell Carcinoma
Author(s) -
Mydlarz Wojciech K.,
Liu Jia,
Blanco Ray,
Fakhry Carole
Publication year - 2014
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599814549181
Subject(s) - medicine , head and neck , basal cell , primary (astronomy) , head and neck squamous cell carcinoma , primary tumor , ultrasound , head and neck cancer , pathology , oncology , radiology , cancer , surgery , radiation therapy , metastasis , physics , astronomy
Head and neck squamous cell carcinomas (HNSCCs) of unknown primary site (UP) account for approximately 4% of HNSCCs.1 These cases have historically been subclinical tumors arising from the nasopharynx, hypopharynx, or oropharynx. In the era of human papillomavirus (HPV)–positive HNSCCs, the presence of HPV in cervical malignancy of UP has been strongly associated with oropharyngeal primary tumors.2 Tumors that are HPV–positive are typically small and arise from cryptic lingual and palatine lymphoid tissues, rendering primary tumor detection challenging.3 The traditional diagnostic paradigm for finding the primary tumor consists of a physical examination, fiber-optic laryngoscopy, and imaging. If these techniques are unsuccessful, operative examination under anesthesia is warranted, including direct laryngoscopy with “blind” biopsies directed at the nasopharynx, hypopharynx, oropharynx, larynx, and palatine and lingual tonsillectomy. Failure to identify the primary tumor site subsequently necessitates radiation of Waldeyer’s ring and concurrent chemotherapy. This report shows that transcervical ultrasound (US) can be used to localize oropharyngeal tumors. The study was reviewed and approved by the Greater Baltimore Medical Center Institutional Review Board.