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

• Published in: Acta oto-laryngologica 2018-10, Vol.138 (10), p.930-936
• Main Authors: Aro, Katri, Bäck, Leif, Mäkitie, Antti, Tapiovaara, Laura
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma - mortality; Carcinoma - secondary; Carcinoma - therapy; Diagnostics; Disease-Free Survival; Female; head and neck cancer; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - secondary; Head and Neck Neoplasms - therapy; Humans; Male; Medicin och hälsovetenskap; Melanoma - mortality; Melanoma - secondary; Melanoma - therapy; metastasis; Middle Aged; Neoplasms, Unknown Primary - diagnosis; Neoplasms, Unknown Primary - mortality; Neoplasms, Unknown Primary - therapy; Positron Emission Tomography Computed Tomography; Retrospective Studies; survival; Survival Rate; unknown primary
• ISSN: 0001-6489; 1651-2251; 1651-2251
• DOI: 10.1080/00016489.2018.1484567

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.