Carole Fakhry1, Nishant Agrawal2, Joseph Califano3, Barbara Messing4, Jia Liu2, John Saunders3, Patrick Ha3, Stephanie Coquia5, Ulrike Hamper5, Maura Gillison6, Ray Blanco3. 1. Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: cfakhry@jhmi.edu. 2. Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States. 3. Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States. 4. Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States. 5. Department of Radiology, Johns Hopkins Medicine, Baltimore, MD, United States. 6. Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, United States.
Abstract
BACKGROUND: Although human papillomavirus detection in cervical lymph nodes of head and neck squamous cell cancers (HNSCC) of unknown primary site (UP) is indicative of a primary tumor of the oropharynx (OP), localization can remain elusive. Therefore, we investigated ultrasonography (US) for the identification of the primary tumor. METHODS: Eligible cases had HNSCC of UP after evaluation by a head and neck surgical oncologist. Controls were healthy volunteers. Transcervical and intraoral ultrasonography was performed by a standard protocol using convex (3.75-6.0 MHz and 5-7.5 MHz) transducers. US findings were compared with operative examination (exam under anesthesia, direct laryngoscopy) and biopsies. The primary outcome of interest was the presence or absence of a lesion on US. RESULTS: 10 cases and 20 controls were enrolled. PET/CT scans were negative/nonspecific (9), or suspicious (1) for a primary lesion. On US, predominantly hypoechoic (9 of 10) lesions were visualized consistent with base of tongue (n=7) or tonsil (n=3) primary tumors. On operative examination, 5 of 10 were appreciated. Two additional primaries were confirmed with biopsies "directed" by preoperative US. This represents an overall diagnostic rate of 70%, which is 20% higher than our detection rate for 2008-2010. The three cases in which a suspicious lesion was visualized on US, yet remained UP despite further interventions, could represent false positives, misclassification or operator variability. No lesions were suspected among the controls. CONCLUSION: Ultrasound has promise for detection of UPs of the OP and therefore warrants further investigation.
BACKGROUND: Although human papillomavirus detection in cervical lymph nodes of head and neck squamous cell cancers (HNSCC) of unknown primary site (UP) is indicative of a primary tumor of the oropharynx (OP), localization can remain elusive. Therefore, we investigated ultrasonography (US) for the identification of the primary tumor. METHODS: Eligible cases had HNSCC of UP after evaluation by a head and neck surgical oncologist. Controls were healthy volunteers. Transcervical and intraoral ultrasonography was performed by a standard protocol using convex (3.75-6.0 MHz and 5-7.5 MHz) transducers. US findings were compared with operative examination (exam under anesthesia, direct laryngoscopy) and biopsies. The primary outcome of interest was the presence or absence of a lesion on US. RESULTS: 10 cases and 20 controls were enrolled. PET/CT scans were negative/nonspecific (9), or suspicious (1) for a primary lesion. On US, predominantly hypoechoic (9 of 10) lesions were visualized consistent with base of tongue (n=7) or tonsil (n=3) primary tumors. On operative examination, 5 of 10 were appreciated. Two additional primaries were confirmed with biopsies "directed" by preoperative US. This represents an overall diagnostic rate of 70%, which is 20% higher than our detection rate for 2008-2010. The three cases in which a suspicious lesion was visualized on US, yet remained UP despite further interventions, could represent false positives, misclassification or operator variability. No lesions were suspected among the controls. CONCLUSION: Ultrasound has promise for detection of UPs of the OP and therefore warrants further investigation.
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