Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors.

Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors.:

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Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors.

Otolaryngol Head Neck Surg. 2020 Jan 28;:194599819900794

Authors: Herruer JM, Taylor SM, MacKay CA, Ubayasiri KM, Lammers D, Kuta V, Bullock MJ, Corsten MJ, Trites JRB, Rigby MH

Abstract

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.

PMID: 31987002 [PubMed - as supplied by publisher]