An evaluation of the diagnostic methods in head and neck cancer of unknown primary site

Abstract

Background: Various detection methods to identify the primary in head and neck cancer of unknown primary (HN-CUP) require evaluation to improve and standardize management.

Objectives: To evaluate the use of different diagnostic methods, which aim at decreasing the incidence of HN-CUP.

Material and methods: We conducted a retrospective analysis of patients with HN-CUP at the Helsinki University Hospital during 1995–2011. We evaluated clinical assessment, definitive treatment, histopathology, and follow up. We analyzed the success in identifying the primary site to show any changes in diagnostic methods over time.

Results: Frequency of HN-CUP and success in identifying the primary site have remained constant despite the addition of PET-CT and determination of human papilloma virus (HPV) status in diagnostics. Among 133 patients, the diagnostic work up identified the primary site in 53% and the oropharynx predominated (69%). This left 85 patients with HN-CUP and 5-year overall and disease-free survival rates were 71 and 69%, respectively.

Conclusions: Panendoscopy including tonsillectomy should not be omitted in the work up.

Significance: We demonstrate a steady frequency of HN-CUP and constant success in identifying the primary site. Detection of a primary later in the follow up did not impact the survival.

Chinese abstract

背景：鉴定原发性不明的头颈部癌（HN-CUP）的原发病灶的各种检测方法需要得以评估以改善其规范及运用。

目的：评估不同诊断方法的使用。这些方法旨在降低HN-CUP的发病率。

材料和方法：我们在1995 - 2011年期间在赫尔辛基大学医院对HN-CUP患者进行了回顾性分析。我们评估了临床检测、确定性治疗、组织病理学和随访。我们分析了确定原发病灶的成功率, 以显示随着时间的推移诊断方法有无任何变化。

结果：尽管在诊断中增加了PET-CT并确定了人类乳头状瘤病毒（HPV）状态, 但HN-CUP的发生频率和识别原发病灶的成功率仍保持不变。在133例患者中, 诊断工作发现原发病灶占53％, 其中口咽占多数（占69％）。其余85名患者患HN-CUP和具5年总体无病生存率分别占71％和69％。

结论：包括扁桃体切除术在内的内窥镜检查在确诊中是必须的。

意义：我们展示出HN-CUP的稳定频率以及确定原发病灶方面的不断成功。在后续检测中发现原发病灶, 对生存并无影响。

Keywords:

• Diagnostics
• head and neck cancer
• metastasis
• survival
• unknown primary

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Sigrid Jusélius Foundation, the Finnish Otorhinolaryngology Research Foundation, and the Helsinki University Hospital Research Funds.