The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers

Carole Fakhry, Nishant Agrawal, Joseph Califano, Barbara Messing, Jia Liu, John Saunders, Patrick Ha, Stephanie Coquia, Ulrike Maria Hamper, Maura Gillison, Ray Gervacio F. Blanco

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)640-645
Number of pages6
JournalOral Oncology
Volume50
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Squamous Cell Neoplasms
Head and Neck Neoplasms
Ultrasonography
Head
Oropharynx
Biopsy
Neoplasms
Laryngoscopy
Palatine Tonsil
Transducers
Tongue
Healthy Volunteers
Neck
Anesthesia
Lymph Nodes

Keywords

  • Head and neck cancer
  • Human papillomavirus (HPV)
  • Oropharynx neoplasm
  • Ultrasonography
  • Unknown primary

ASJC Scopus subject areas

  • Oncology
  • Oral Surgery
  • Cancer Research
  • Medicine(all)

Cite this

The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers. / Fakhry, Carole; Agrawal, Nishant; Califano, Joseph; Messing, Barbara; Liu, Jia; Saunders, John; Ha, Patrick; Coquia, Stephanie; Hamper, Ulrike Maria; Gillison, Maura; Blanco, Ray Gervacio F.

In: Oral Oncology, Vol. 50, No. 7, 2014, p. 640-645.

Research output: Contribution to journalArticle

Fakhry, Carole ; Agrawal, Nishant ; Califano, Joseph ; Messing, Barbara ; Liu, Jia ; Saunders, John ; Ha, Patrick ; Coquia, Stephanie ; Hamper, Ulrike Maria ; Gillison, Maura ; Blanco, Ray Gervacio F. / The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers. In: Oral Oncology. 2014 ; Vol. 50, No. 7. pp. 640-645.
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T1 - The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers

AU - Fakhry, Carole

AU - Agrawal, Nishant

AU - Califano, Joseph

AU - Messing, Barbara

AU - Liu, Jia

AU - Saunders, John

AU - Ha, Patrick

AU - Coquia, Stephanie

AU - Hamper, Ulrike Maria

AU - Gillison, Maura

AU - Blanco, Ray Gervacio F.

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Head and neck cancer

KW - Human papillomavirus (HPV)

KW - Oropharynx neoplasm

KW - Ultrasonography

KW - Unknown primary

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