Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors.
In: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jg. 162 (2020-03-01), Heft 3, S. 313-318
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Zugriff:
Objective: Surgical management of the unknown primary head and neck squamous cell carcinoma (UP HNSCC) remains controversial due to challenging clinical diagnosis. This study compares positron emission tomography-computed tomography (PET-CT) findings with intraoperative identification of primary tumors and compares intraoperative frozen-section margins to final histopathology. In addition, adjuvant therapy indications are provided.
Study Design: Prospective cohort study.
Setting: Academic university hospital.
Subjects and Methods: Sixty-one patients with UP HNSCC were included. Patients received PET-CT, followed by oropharyngeal transoral laser microsurgery (TLM). Margins were assessed intraoperatively using frozen sections and afterward by final histopathology. Adjuvant treatment was based on final histopathology.
Results: The sensitivity of localizing the primary tumor with PET-CT was 50.9% with a specificity of 82.5%. The primary tumor was found intraoperatively on frozen sections in 82% (n = 50) of patients. Five more tumors were identified on final histopathology, leading to a total of 90% (n = 55). Of the 50 intraoperatively found tumors, 98% (n = 49) had negative margins on frozen sections, and 90% (n = 45) were truly negative on final histopathology. Eighteen patients (29.5%) avoided adjuvant treatment.
Conclusion: PET-CT localized the primary tumor in fewer than half the cases. This protocol identified 90% of primary tumors. Intraoperative frozen-section margin assessment has shown potential with a specificity of 92% compared to final histopathology. As a result, adjuvant therapy was avoided in almost one-third of our patients.
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Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors.
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Autor/in / Beteiligte Person: | Herruer, JM ; Taylor, SM ; MacKay, CA ; Ubayasiri, KM ; Lammers, D ; Kuta, V ; Bullock, MJ ; Corsten, MJ ; Trites, JRB ; Rigby, MH |
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Zeitschrift: | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jg. 162 (2020-03-01), Heft 3, S. 313-318 |
Veröffentlichung: | 2023- : [Oxford] : Wiley ; <i>Original Publication</i>: [Rochester, Minn.] : The Academy, [c1981-, 2020 |
Medientyp: | academicJournal |
ISSN: | 1097-6817 (electronic) |
DOI: | 10.1177/0194599819900794 |
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