Role of Tonsillectomy in the Management of Carcinomas of Unknown Primary of the Head and Neck: A Retrospective Study Based on p16 Analysis.

Abstract

PURPOSE:

To evaluate the impact of tonsillectomy on the detection of the primary tumor, based on p16 immunohistochemistry analysis, in patients with cervical unknown primary of squamous cell carcinoma (SCC-CUP).

METHODS:

This was a retrospective study of 63 patients, included from January 2008 to December 2017 in a single institution. All patients had an initial assessment with physical examination, CT scan of the neck and chest, whole body FDG-PET CT, and endoscopy under general anesthesia, which failed to determine the primary tumor.

RESULTS:

Forty-seven out of the 63 patients had an ipsi- or bilateral tonsillectomy which revealed 12 tonsil cancers (26%). The tonsil primary was ipsilateral to positive nodes in 10 cases, contralateral in 1 case and, in 1 case, the patient had bilateral neck involvement. The analysis of the p16 status was carried out in 41/63 patients (65%). Among the 32 patients who had a p16 analysis and tonsillectomy, the rate of primary detection was 59% (10/17) for p16-postives and 0% (0/15) for p16-negatives (p < 0.001).

CONCLUSION:

These results suggest that an extended work-up should be systematically proposed including bilateral tonsillectomy (+/- mucosectomy of the base of tongue) in SCC-CUP p16-positive patients but not in p16-negatives.

• Authors: Pauline Podeur, Julien Mancini, Jean Delgrande, Laure Santini, Sébastien Salas, Stéphanie Wong, Antoine Giovanni, Patrick Dessi, Justin Michel, Thomas Radulesco, Nicolas Fakhry
• Journal: Frontiers in oncology (Front Oncol) Vol. 10 Pg. 594168 ( 2020) ISSN: 2234-943X [Print] Switzerland
• PMID: 33194759 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Podeur, Mancini, Delgrande, Santini, Salas, Wong, Giovanni, Dessi, Michel, Radulesco and Fakhry.