The role of non-oropharyngeal biopsies in head and neck squamous cell carcinoma of unknown primary: A systematic review

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY Clinical Otolaryngology Pub Date : 2024-04-25 DOI:10.1111/coa.14157

C. M. Bowe, M. Garg

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Abstract

Introduction

This systematic review aims to evaluate the role of biopsies in non-oropharyngeal subsites in patients with cervical metastasis from head and neck squamous cell carcinoma of unknown primary (HNSCCUP).

Methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles that encompassed non-oropharyngeal biopsies in HNSCCUP as part of the diagnostic work-up were selected and analysed.

Results

A comprehensive search strategy was used to search relevant literature in PubMed from inception to October 2021. Eleven articles out of 860 were included, comprising 990 patients. There are no randomised control trials comparing the outcomes of survival and or locoregional control between patients who have or have not undergone non-targeted biopsies of non-oropharyngeal sub-sites for HNSCCUP.

Several retrospective studies which showed an extremely low yield from random biopsies (range of yield, 0%–9%) of non-oropharyngeal subsites. Even targeted biopsies showed a low yield (range of yield, 0.6%–16.6%) from non-oropharyngeal subsites. The primary site identified for Epstein–Barr virus (EBV) positive cervical lymph nodes with an unknown primary is mainly the nasopharynx (51.7%). Narrow band imaging (NBI) (sensitivity range, 64%–91%) helps in the detection of primaries to target biopsies in non-oropharyngeal subsites.

Conclusions

On the basis of this systematic review, it is not appropriate to offer biopsies of clinically and radiologically normal upper aerodigestive tract mucosa at non-oropharyngeal sites. Offer nasopharyngeal biopsies when the cervical node sampling reveals EBV-positive metastasis. Where available, NBI should be used to help detect and target biopsies in non-oropharyngeal subsites.

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非口咽活检在原发灶不明的头颈部鳞状细胞癌中的作用：系统综述

导言本系统综述旨在评估原发灶不明的头颈部鳞状细胞癌（HNSCCUP）颈部转移患者非口咽部位活检的作用。方法本系统综述根据系统综述和荟萃分析首选报告项目（PRISMA）声明进行。结果采用综合检索策略在 PubMed 上检索了从开始到 2021 年 10 月的相关文献。在860篇文献中，有11篇被收录，其中包括990名患者。目前还没有随机对照试验对接受或未接受非靶向性非咽部亚部位活检的 HNSCCUP 患者的生存率和局部控制率进行比较。即使是有针对性的活检，非口咽部亚部位的阳性率也很低（阳性率范围为 0.6%-16.6%）。原发部位不明的爱泼斯坦-巴氏病毒（EBV）阳性颈淋巴结的主要部位是鼻咽部（51.7%）。窄带成像（NBI）（灵敏度范围为 64%-91%）有助于检测原发病灶，从而确定非口咽部位的活检目标。结论根据本系统综述，在非口咽部位对临床和放射学上正常的上消化道黏膜进行活检是不合适的。当颈结节取样发现 EBV 阳性转移时，应进行鼻咽活检。如有条件，应使用 NBI 帮助检测非口咽部位并确定活检目标。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.