Authors |
Year |
Origin |
Study Design |
N CUP |
Workup |
BOT Pickup |
Synchronous/Contralateral |
HPV/P16 Rate |
Complications |
Recommendations |
Kubik et a29
|
2021
|
USA/Denmark
|
RS
|
23
|
Negative (inc CT/PETCT).PE - IL PT and Biopsy.
Then TORS BL TBM.
4/23 had positive PETCT, 1/4 correlating with positive Biopsy.
|
13%
(3/23)
|
0%
|
Negative 100% (inclusion negative)
|
4.3% (1/23) Haemorrhage, managed conservatively
|
TORS TBM may not be indicated HPV negative
|
Nilsson et a30
May want to inc to TOR
|
2020
|
Sweden
|
Prospective
|
13
|
Negative PETCT & PE blind biopsy inc BOT, IL PT.
Then TORS IL TBM
|
38%
|
|
Benefit may reduce HPV positive
|
No serious
|
IL TBM.
|
Sudoko et al31
|
2018
|
USA
|
RS
|
16
|
Negative Ex, PETCT, PE and Biopsy, PT. Then TORS/TLM/ IL/BL TBM
|
25% (4/16)
(1/6 TOR, 2/7 TLM, 1/3 TMC)
|
|
75%
|
19% bleeding “not related LT”
|
TBM considered Dx algorithm. UL if consecutive PT (theoretical risk
stenosis)
|
Davies-Husband32
Endoscopic cautery’s put below
|
2018
|
UK
|
PS
|
9
|
Negative MRI/PETCT, PE and blind BOT Biopsy and PT. Then endoscopic BL
electrocautery
|
44.4% (4/9)
|
0%
|
77.8% all patients.
100% tongue primary
|
No surgical
|
TBM with electrocautery safe and effective. Quickens Dx pathway and
avoids pan-mucosal irradiation
|
Winter et al33
|
2017 |
UK |
PS Multi-centre |
32 |
Negative Ex, radiological and PETCT, and ex under anaesthesia, PT, then
TORS TBM |
53% (17/32) |
CL 12% (2/17) |
72% positive |
9% (66% of
these post-op bleed - Cx) |
Support for use TBM in identifying primary
site. Should be further explored |
Krishnan, Connell and Ofo34
|
2016
|
Australia
|
RS
|
7
|
Ex, CT/MRI, PETCT, PE PT and TORS IL/BL BOT.
Not all workup negative
|
71.4% (5/7)
|
|
85.7% overall.
100% for BOT primary.
|
14.3% Candida.
“No surgical”
|
TORS TBM utilised to good effect HNSCCUP. Incorporating into surgical Dx
and Tx pathway offers low complication rates, reduced morbidity and
improved tumour identification
|
Channir et al35
May want to inc TOR
|
2015, 28-
|
Denmark
|
RS
|
13
|
Full negative including PETCT, EUA inc random Biopsy BOT and BL PT. TORS
BL BOT
|
54% (7/13)
|
|
69.2% overall.
100% BOT
|
30.8%
Tongue sensitivity, difficulty breathing (ITU)/PE, bleeding, severe
pain
|
Detection primary tumour with combined TORS and HPV DNA and P16 testing
feasible
|
Mehta et al36
|
2013 |
USA |
RS |
10 |
CT/MRI &/or
PETCT (some positive), endoscopy, BL PT/Biopsy’s. BOT/pharynx. Then TORS
BL BOT |
90% (9/10) |
11.1% (1/9)CL |
80% positive overall, 88.9%
Positive BOT |
10% gastrostomy |
TORS BOT highly efficacious and
reproducible detecting small HPV positive primaries where traditional
methods failed |