Abstract
In an era of advanced diagnostics, metastasis to cervical lymph nodes from an occult primary tumor is a rare clinical entity and accounts for approximately 3% of head and neck malignancies. Histologically, two thirds of cases are squamous cell carcinomas (SCCs), with other tissue types less common in the neck. With modern imaging and tissue examinations, a primary tumor initially undetected on physical examination is revealed in >50% of patients and the site of the index primary can be predicted with a high level of probability. In the present review, the range and limitations of diagnostic procedures are summarized and the optimal diagnostic workup is proposed. Initial preferred diagnostic procedures are a fine-needle aspiration biopsy (FNAB) and imaging. This allows directed surgical biopsy (such as tonsillectomy), based on the preliminary findings, and prevents misinterpretation of postsurgical images. When no primary lesion is suggested after imaging and panendoscopy, and for patients without a history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus (HPV) and/or Epstein-Barr virus (EBV) is important. Head Neck, 2013
| Original language | English (US) |
|---|---|
| Pages (from-to) | 123-132 |
| Number of pages | 10 |
| Journal | Head and Neck |
| Volume | 35 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2013 |
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All Science Journal Classification (ASJC) codes
- Otorhinolaryngology
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Contemporary management of lymph node metastases from an unknown primary to the neck : I. A review of diagnostic approaches. / Strojan, Primož; Ferlito, Alfio; Medina, Jesus E.; Woolgar, Julia A.; Rinaldo, Alessandra; Robbins, K. Thomas; Fagan, Johannes J.; Mendenhall, William M.; Paleri, Vinidh; Silver, Carl E.; Olsen, Kerry D.; Corry, June; Suárez, Carlos; Rodrigo, Juan P.; Langendijk, Johannes A.; Devaney, Kenneth O.; Kowalski, Luiz P.; Hartl, Dana M.; Haigentz, Missak; Werner, Jochen A.; Pellitteri, Phillip K.; De Bree, Remco; Wolf, Gregory T.; Takes, Robert P.; Genden, Eric M.; Hinni, Michael L.; Mondin, Vanni; Shaha, Ashok R.; Barnes, Leon.
In: Head and Neck, Vol. 35, No. 1, 01.01.2013, p. 123-132.Research output: Contribution to journal › Review article
TY - JOUR
T1 - Contemporary management of lymph node metastases from an unknown primary to the neck
T2 - I. A review of diagnostic approaches
AU - Strojan, Primož
AU - Ferlito, Alfio
AU - Medina, Jesus E.
AU - Woolgar, Julia A.
AU - Rinaldo, Alessandra
AU - Robbins, K. Thomas
AU - Fagan, Johannes J.
AU - Mendenhall, William M.
AU - Paleri, Vinidh
AU - Silver, Carl E.
AU - Olsen, Kerry D.
AU - Corry, June
AU - Suárez, Carlos
AU - Rodrigo, Juan P.
AU - Langendijk, Johannes A.
AU - Devaney, Kenneth O.
AU - Kowalski, Luiz P.
AU - Hartl, Dana M.
AU - Haigentz, Missak
AU - Werner, Jochen A.
AU - Pellitteri, Phillip K.
AU - De Bree, Remco
AU - Wolf, Gregory T.
AU - Takes, Robert P.
AU - Genden, Eric M.
AU - Hinni, Michael L.
AU - Mondin, Vanni
AU - Shaha, Ashok R.
AU - Barnes, Leon
PY - 2013/1/1
Y1 - 2013/1/1
N2 - In an era of advanced diagnostics, metastasis to cervical lymph nodes from an occult primary tumor is a rare clinical entity and accounts for approximately 3% of head and neck malignancies. Histologically, two thirds of cases are squamous cell carcinomas (SCCs), with other tissue types less common in the neck. With modern imaging and tissue examinations, a primary tumor initially undetected on physical examination is revealed in >50% of patients and the site of the index primary can be predicted with a high level of probability. In the present review, the range and limitations of diagnostic procedures are summarized and the optimal diagnostic workup is proposed. Initial preferred diagnostic procedures are a fine-needle aspiration biopsy (FNAB) and imaging. This allows directed surgical biopsy (such as tonsillectomy), based on the preliminary findings, and prevents misinterpretation of postsurgical images. When no primary lesion is suggested after imaging and panendoscopy, and for patients without a history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus (HPV) and/or Epstein-Barr virus (EBV) is important. Head Neck, 2013
AB - In an era of advanced diagnostics, metastasis to cervical lymph nodes from an occult primary tumor is a rare clinical entity and accounts for approximately 3% of head and neck malignancies. Histologically, two thirds of cases are squamous cell carcinomas (SCCs), with other tissue types less common in the neck. With modern imaging and tissue examinations, a primary tumor initially undetected on physical examination is revealed in >50% of patients and the site of the index primary can be predicted with a high level of probability. In the present review, the range and limitations of diagnostic procedures are summarized and the optimal diagnostic workup is proposed. Initial preferred diagnostic procedures are a fine-needle aspiration biopsy (FNAB) and imaging. This allows directed surgical biopsy (such as tonsillectomy), based on the preliminary findings, and prevents misinterpretation of postsurgical images. When no primary lesion is suggested after imaging and panendoscopy, and for patients without a history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus (HPV) and/or Epstein-Barr virus (EBV) is important. Head Neck, 2013
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U2 - 10.1002/hed.21898
DO - 10.1002/hed.21898
M3 - Review article
VL - 35
SP - 123
EP - 132
JO - Head and Neck
JF - Head and Neck
SN - 1043-3074
IS - 1
ER -