Role of Tonsillectomy in the Management of Carcinomas of Unknown Primary of the Head and Neck: A Retrospective Study Based on p16 Analysis

• Published in: Frontiers in oncology 2020-10, Vol.10, p.594168-594168
• Main Authors: Podeur, Pauline, Mancini, Julien, Delgrande, Jean, Santini, Laure, Salas, Sébastien, Wong, Stéphanie, Giovanni, Antoine, Dessi, Patrick, Michel, Justin, Radulesco, Thomas, Fakhry, Nicolas
• Format: Article
• Language: English
• Subjects: head and neck cancer; human papillomavirus; Life Sciences; Oncology; oropharyngeal cancer; squamous cell carcinoma; unknown primary
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2020.594168

To evaluate the impact of tonsillectomy on the detection of the primary tumor, based on p16 immunohistochemistry analysis, in patients with cervical unknown primary of squamous cell carcinoma (SCC-CUP). This was a retrospective study of 63 patients, included from January 2008 to December 2017 in a single institution. All patients had an initial assessment with physical examination, CT scan of the neck and chest, whole body FDG-PET CT, and endoscopy under general anesthesia, which failed to determine the primary tumor. Forty-seven out of the 63 patients had an ipsi- or bilateral tonsillectomy which revealed 12 tonsil cancers (26%). The tonsil primary was ipsilateral to positive nodes in 10 cases, contralateral in 1 case and, in 1 case, the patient had bilateral neck involvement. The analysis of the p16 status was carried out in 41/63 patients (65%). Among the 32 patients who had a p16 analysis and tonsillectomy, the rate of primary detection was 59% (10/17) for p16-postives and 0% (0/15) for p16-negatives (p < 0.001). These results suggest that an extended work-up should be systematically proposed including bilateral tonsillectomy (+/- mucosectomy of the base of tongue) in SCC-CUP p16-positive patients but not in p16-negatives.