The prevalence of oropharyngeal squamous cell carcinoma in patients
admitted with symptoms of peritonsillar abscess or cellulitis: a
retrospective multicentre study
Abstract
ABSTRACT Objectives Anecdotal evidence suggests that oropharyngeal
squamous cell carcinoma (OPSCC) should be suspected in patients
presenting with symptoms of peritonsillar abscess (PTA) or cellulitis
(PTC). The aim of this study was to estimate the prevalence of OPSCC in
patients presenting with symptoms of PTA/PTC. Method, Setting and
Participants We retrospectively identified all adults with a coded
diagnosis of PTA or PTC who presented between 2012-2016 inclusive,
across six ENT units in ——–. Records were compared to that of the
centralised regional head and neck cancer database. The clinical records
of a subset of patients were reviewed for the purposes of data
validation. Results A total of 1975 patients with PTA/PTC were
identified. Three patients were subsequently diagnosed with OPSCC. None
of the three actually had an objective underlying diagnosis of PTA/PTC
on the same side. The prevalence of OPSCC in patients admitted with
symptoms of PTA/PTC was 0.15%, or approximately 1:650 admissions. The
records of 510 patients who presented over a one-year period (2016) were
reviewed in even greater detail. There were 298 patients with PTA
(59.4%), 151 with PTC (29.1%) and 61 had an alternative diagnosis
(11.9%). High risk features (age ≥40, tonsillar asymmetry or tonsillar
lesion) were present in 106 patients (24%). Urgent follow up was
expedited for 77 patients (73%). Conclusion This study estimates the
risk of OPSCC in patients with peritonsillar symptoms. The prevalence is
low, even in a region with a relatively heavy disease burden. Clinicians
should, however, retain a high level of suspicion in patients with
persistent symptoms.