title: The role of tonsillectomy in the initial diagnostic work-up of head and  neck squamous cell carcinoma of unknown primary.
abstract: OBJECTIVE
  The aim of the present study was to determine the value of tonsillectomy in the initial diagnostic work-up of head and neck squamous cell carcinoma of unknown primary (HNSCCUP).
  
  
  METHODS
  A single-center retrospective study (1999–2012) included 45 patients. All cases underwent physical examination, panendoscopy and contrast-enhanced neck and chest CT scan; 27 (60%)also underwent 18-FDG PET scan. Imaging was systematically performed before panendoscopy. In 34 cases (75%), histologic tonsil samples ipsilateral to the HNSCCUP were collected (28 tonsillectomies and 6 biopsies) during panendoscopy. Categoric variables were compared on Chi-square test.
  
  
  RESULTS
  Clinical examination and CT did not identify any primary tumor. In 13 cases (38%), invasive squamous cell carcinoma (SCC) was diagnosed on histological samples (12 tonsillectomies, 1 biopsy). For these 13 cases, lymph nodes were located in the upper or middle jugular group, and in 3 cases lymph nodes were cystic on CT scan. In 7 cases (26%), there was an abnormal tonsillar 18-FDG uptake ipsilateral to the cervical lymphadenopathy; tonsillectomy was performed, and SCC was found in 5 of these cases:i.e., 18-FDG PET showed sensitivity and specificity of respectively 55.5 and 88.8%.
  
  
  CONCLUSIONS
  Tonsillectomy has a role in the initial diagnostic work-up of HNSCCUP. It is especially useful when lymph nodes are located in the upper and/or middle jugular group with a cystic aspect on CT.
authors.affiliation: Pôle TCCR, clinique universitaire d’ORL, CHU de Grenoble, 1, avenue des Maquis-du-Grésivaudan, 38330 Grenoble cedex 09, France. eberta@chu-grenoble.fr
authors.forename: E
authors.initials: E
authors.lastname: Berta
authors.forename: I
authors.initials: I
authors.lastname: Atallah
authors.forename: E
authors.initials: E
authors.lastname: Reyt
authors.forename: E
authors.initials: E
authors.lastname: Boyer
authors.forename: A
authors.initials: A
authors.lastname: Karkas
authors.forename: C-A
authors.initials: CA
authors.lastname: Righini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D008206:Lymphatic Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009382:Neoplasms, Unknown Primary; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18