Abstract
Background
Patients presenting with head and neck squamous cell carcinoma of
unknown primary (HNSCCUP) remain challenging clinical scenarios as large
variation exists in practices used to locate the primary.
Objective
To perform a systematic review of the literature and offer
recommendations for oropharyngeal biopsies in HNSCCUP.
Method
Pubmed, Medline and Embase were searched to identify studies from
inception to October 2021. The Preferred Reporting Items for Systematic
Reviews and Meta-analyses (PRISMA) guidelines were followed.
Results
483 articles were included and screened, 40 studies met the inclusion
criteria, including over 3400 patients from the original articles and
1575 patients from 3 meta-analyses. The primary site identification rate
following random biopsies or deep tissue biopsies is less than 5% in
most studies. The mean detection rate following ipsilateral
tonsillectomy is 34%; two pooled analyses indicate that the mean
detection rate following tongue base mucosectomy is 64%, with this
figure rising when the tonsils are negative.
Conclusions
High level evidence is lacking, with heterogeneity in the reported
studies. Published meta analyses are based on retrospective data. There
is little evidence supporting the practice of random/non-directed
oropharyngeal biopsies. Available evidence supports palatine
tonsillectomy and tongue base mucosectomy compared to deep tissue
biopsies.