Premium
Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches
Author(s) -
Strojan Primož,
Ferlito Alfio,
Medina Jesus E.,
Woolgar Julia A.,
Rinaldo Alessandra,
Robbins K. Thomas,
Fagan Johannes J.,
Mendenhall William M.,
Paleri Vinidh,
Silver Carl E.,
Olsen Kerry D.,
Corry June,
Suárez Carlos,
Rodrigo Juan P.,
Langendijk Johannes A.,
Devaney Kenneth O.,
Kowalski Luiz P.,
Hartl Dana M.,
Haigentz Missak,
Werner Jochen A.,
Pellitteri Phillip K.,
de Bree Remco,
Wolf Gregory T.,
Takes Robert P.,
Genden Eric M.,
Hinni Michael L.,
Mondin Vanni,
Shaha Ashok R.,
Barnes Leon
Publication year - 2013
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.21898
Subject(s) - medicine , occult , biopsy , radiology , cervical lymph nodes , lymph node , primary tumor , neck mass , metastasis , head and neck , pathology , surgery , cancer , alternative medicine
In an era of advanced diagnostics, metastasis to cervical lymph nodes from an occult primary tumor is a rare clinical entity and accounts for approximately 3% of head and neck malignancies. Histologically, two thirds of cases are squamous cell carcinomas (SCCs), with other tissue types less common in the neck. With modern imaging and tissue examinations, a primary tumor initially undetected on physical examination is revealed in >50% of patients and the site of the index primary can be predicted with a high level of probability. In the present review, the range and limitations of diagnostic procedures are summarized and the optimal diagnostic workup is proposed. Initial preferred diagnostic procedures are a fine‐needle aspiration biopsy (FNAB) and imaging. This allows directed surgical biopsy (such as tonsillectomy), based on the preliminary findings, and prevents misinterpretation of postsurgical images. When no primary lesion is suggested after imaging and panendoscopy, and for patients without a history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus (HPV) and/or Epstein–Barr virus (EBV) is important. Head Neck, 2013