title: Transoral robotic biopsy of the tongue base: A novel paradigm in the evaluation of unknown primary tumors of the head and neck.
abstract: BACKGROUND
  Squamous cell carcinoma of the head and neck can present as a cervical metastasis from an unknown primary site. The standard diagnostic workup includes panendoscopy and directed biopsies but this will fail to identify a portion of unknown primary tumors.
  
  
  METHODS
  Herein, we present a case report of a male patient with an unknown primary tumor in which the da Vinci surgical robot was used to evaluate the tongue base.
  
  
  RESULTS
  Clinical evaluation, imaging, and panendoscopy with directed biopsies failed to detect the primary tumor site. Robot-assisted biopsy of a broad area of the tongue base, incorporating submucosal tissue, identified the primary tumor with minimal postoperative morbidity.
  
  
  CONCLUSIONS
  Failure to localize an unknown primary tumor often results in widespread irradiation of the upper aerodigestive tract, inducing significant morbidity. Robot-assisted biopsies of the tongue base may identify unknown primaries that would otherwise have been missed through standard directed biopsy techniques.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA.
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Abuzeid
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.forename: Vasu
authors.initials: V
authors.lastname: Divi
mesh_terms: D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000473:pathology / Q000601:surgery; D012371:Robotics / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D014059:Tongue / Q000473:pathology* / Q000601:surgery