Head Neck 1998 Dec;20(8):739-44
Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph
nodes from an unknown head and neck primary site.
Mendenhall WM, Mancuso AA, Parsons JT, Stringer SP, Cassisi NJ.
BACKGROUND: The purpose of this study was to evaluate the efficacy of the modern
diagnostic evaluation for squamous cell carcinoma metastatic to cervical lymph
nodes from an unknown head and neck primary site. METHODS: One hundred thirty
patients were evaluated between June 1983 and June 1997. All underwent head and
neck examinations, head and neck computed tomography (CT), and/or magnetic
resonance imaging (MRI) scans, panendoscopies, and biopsies of head and neck
mucosal sites. Twenty-four patients underwent 2-[fluorine-18]-2-deoxy-D-glucose
(FDG) single photon emission computed tomography (SPECT); 34 patients underwent
tonsillectomy. RESULTS: The primary site was identified in 56 patients (43%);
the likelihood was increased in patients with suggestive findings on physical
examination and/or radiographic evaluation. Eighty-three percent of the lesions
were located in the tonsillar fossa and base of tongue. Results of FDG-SPECT
scans were positive in 20 patients (83%); the primary tumor was detected in 7
patients (35%). Twelve (35%) of 34 patients who underwent tonsillectomy had a
primary tumor discovered in the tonsillar fossa. Multivariate analysis of
successful primary site detection revealed that suggestive findings on physical
examination (p= .0225) and suggestive findings on CT and/or MRI (p = .0013) were
significantly related to this end point. CONCLUSION: The primary lesion will be
detected in over 40% of patients with physical examination of the head and neck
and CT and/or MRI followed by panendoscopy and biopsies. Limited data pertaining
to FDG-SPECT suggest that this provides additional useful information in a small
subset of patients. Tonsillectomy is useful for those with suggestive findings
on physical examination and/or radiographic evaluation.
