Indications for Oropharyngeal Biopsy in Head and Neck Squamous Cell
Carcinoma of Unknown Primary - A Systematic Review (HNSCCUP)
Abstract
Background Patients presenting with head and neck squamous cell
carcinoma of unknown primary (HNSCCUP) remain challenging clinical
scenarios as large variation exists in practices used to locate the
primary. Objective To perform a systematic review of the literature and
offer recommendations for oropharyngeal biopsies in HNSCCUP. Method
Pubmed, Medline and Embase were searched to identify studies from
inception to October 2021. The Preferred Reporting Items for Systematic
Reviews and Meta-analyses (PRISMA) guidelines were followed. Results 483
articles were included and screened, 40 studies met the inclusion
criteria, including over 3400 patients from the original articles and
1575 patients from 3 meta-analyses. The primary site identification rate
following random biopsies or deep tissue biopsies is less than 5% in
most studies. The mean detection rate following ipsilateral
tonsillectomy is 34%; two pooled analyses indicate that the mean
detection rate following tongue base mucosectomy is 64%, with this
figure rising when the tonsils are negative. Conclusions High level
evidence is lacking, with heterogeneity in the reported studies.
Published meta analyses are based on retrospective data. There is little
evidence supporting the practice of random/non-directed oropharyngeal
biopsies. Available evidence supports palatine tonsillectomy and tongue
base mucosectomy compared to deep tissue biopsies.