Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches.
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.
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
Primož
P
Strojan
Alfio
A
Ferlito
Jesus E
JE
Medina
Julia A
JA
Woolgar
Alessandra
A
Rinaldo
K Thomas
KT
Robbins
Johannes J
JJ
Fagan
William M
WM
Mendenhall
Vinidh
V
Paleri
Carl E
CE
Silver
Kerry D
KD
Olsen
June
J
Corry
Carlos
C
Suárez
Juan P
JP
Rodrigo
Johannes A
JA
Langendijk
Kenneth O
KO
Devaney
Luiz P
LP
Kowalski
Dana M
DM
Hartl
Missak
M
Haigentz
Jochen A
JA
Werner
Phillip K
PK
Pellitteri
Remco
R
de Bree
Gregory T
GT
Wolf
Robert P
RP
Takes
Eric M
EM
Genden
Michael L
ML
Hinni
Vanni
V
Mondin
Ashok R
AR
Shaha
Leon
L
Barnes
D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000473:pathology