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