Mistry et al39
|
2020
|
UK
|
RS
|
28
|
Negative Ex, imaging inc PETCT.
|
67.8% (19/28)
|
47% (9/19)
(3 in BOT and tonsil)
|
37% (7/19)
|
16% (3/19) synchronous BOT and tonsil.
5% CL LT
(3 in BOT and tonsil)
|
82.6%
100% in OP primary
|
10.3% (n=3) bleed - Cx
|
TORS TBM promising technique proffers high yield. Well tolerated with
min morbidity
|
Ryan et al15
|
2019 |
USA |
RS |
110 |
PETCT, PE and
Biopsy, tonsillectomy then TORS TBM (not all negative) |
66% with TORS,
44% before |
57% (8/14) |
36% (17/47) |
17% (2/12 BL TE) in palatine
tonsils |
73% (80/110) |
|
Stepwise approach primary identification
inc. tonsillectomy and TORS TBM |
Hatten et al40
|
2017
|
USA
|
RS
|
60
|
MRI/CT negative. PETCT. PE and Biopsy, IL tonsillectomy, then IL TBM. If
HPV positive CL not resected.
|
80% (48/60)
|
58% (28/48)
|
38% (18/48)
|
|
92% (55/60) enrolled at least one marker
|
13% (8/60):
5% post-op bleed (6% of these RTT)
|
TOR assisted endoscopy useful technique to identify and
de-intensification Tx. Imp identification primary
|
Geltzeiler et al al41
|
2017
|
USA
|
RS
|
64
|
Negative Ex, flexible nasolaryngoscopy, CT &/or PETCT.
DL, TORS LT UL/BL +/- PT UL or BL
|
80% (51/64)
74% (37/50) ID TORS alone
22% (14/64) DL alone
|
86.5% (32/37)
|
13.5% (5/37)
|
12% CL BOT (3/25 underwent BL BOT)
|
96% (n=48)
|
6% (3/50)
4% - RTT bleeding
2%
peri-op feeding tube
Further h 16% gastrostomy feeding 6/12
|
Operative laryngoscopy and TORS efficacious localising primary.
Standardised surgical technique increases diagnostic yield and
decreasing negative margin rate
|
TLM |
|
|
|
|
|
|
|
|
|
|
|
|
Authors |
Year |
Origin |
Study Design |
N |
CT/MRI/PETCT |
Primary
Yield |
BOT |
Tonsil |
Synchronous |
HPV |
Complications |
Recommendations |
Herruer et al42
|
2020
|
Canada
|
PS
|
61
|
PETCT and intraoperative identification. TLM IL PT, IL TBM, CL tonsil,
CL TBM
|
90.1% (55/61) combined PETCT and TLM.
|
|
|
|
91.9% (57/61)
|
27.9% (17 complications in 15 patients) overall - not all TLM
TLM:
12 Delayed recovery swallow - 5 DC NGT, 1 OP bleed (Cx),
3 Neck haematoma 1 chyle leak.
|
PETCT localised tumour less half cases. Addition of TLM improved
identification (90%). Intra-op frozen section margin assessment shown
potential with specificity 92% compared to final histology. As a result
adjuvant therapy avoided almost 1/3 pts
|
Kuta et al43
|
2017 |
Canada |
PS |
27 |
Ex negative.
PETCT (not all negative). TLM Biopsy. IL PT and TBM |
92.6% (25/27) |
48% (12/25) |
52% (13/25) |
|
92.6% (25/27) |
|
Study demonstrated
the efficacy of PETCT TLM protocol detection and therapeutic
perspective |
Graboyes et al44
|
2015
|
USA
|
CS
|
65
|
Negative ex, CT/MRI &/or PETCT. Rigid pharyngoscopy and directed
Biopsy. If negative IL PT, IL TBM and CL 1cm
(Maj TLM small min TOR after microscopy)
|
89% (58/65)
|
41.5% (27/65)
|
52.3% (34/65)
|
5% (3/58) synchronous IL palatine and lingual tonsil n=2, BL palatine
tonsil 1)
|
100% (65/65) inclusion criteria
|
16.9% (11) surgery related):
9.2% (n=6) post-op haemorrhage - surgery or embolisation
7.7% (n=5) shoulder weakness
n=9: CRT complications
|
11/65 from Karni et al (n=30). Transoral approach highly effective Dx
and Tx P16 positive HNSCCUP and laid foundation for for
de-escalation
|
Nagel et al16
|
2014
|
USA
|
RS
|
52
|
Traditional approach inc. PT vs TLM approach IL tonsil, IL TBM then
CL
|
Overall 75% (39/52).
TLM protocol 86.1% (31/36)
Traditional 50% (8/16)
|
65% (n=26)
|
27.5% (n=11)
|
2.3% (n=1 both palatine tonsils)
|
Lingual 92%
Palatine 100%
|
2.8% haemorrhage requiring RTT (n=1). ?Temporary swallow
dysfunction
|
Surgical algorithm UK primary inc TLM-assisted techniques, including
TBM, offers greatest likelihood detecting CUP
|
Karni et al17
|
2013
|
USA
|
RS cohort
|
30 (18 TLM)
|
TLM vs traditional (+/- PT)
TLM: IL tonsil, IL TBM
|
94.4% TLM (17/18), 25% (3/12) traditional
|
60% (12/20)
|
35% (7/20)
|
1/20 in NP and HP (21 complete tumours)
|
|
|
TLM MX occult primary high detection rates and high levels DFS. Detects
and treats
|