Patient-Specific Factors to Differentiate Between Branchial Cleft Cysts and CUP Syndrome: A 10 Year Unicenter Study

Area of Science:

• Otorhinolaryngology
• Oncology
• Diagnostic Imaging

Background:

• Cervical cancer of unknown primary (CUP) presents diagnostic challenges due to its poor prognosis and varied clinical signs.
• Lateral neck cysts (LNC) are a common differential diagnosis, often misidentified before histopathology confirms squamous cell carcinoma.

Purpose of the Study:

• To identify risk factors that distinguish CUP syndrome from LNC.
• To potentially improve diagnostic accuracy and patient prognosis.

Main Methods:

• A cohort study of 244 patients diagnosed with either LNC (n=121) or CUP (n=123) between 2013-2023.
• Patients underwent panendoscopy with lymph node removal.
• Analysis of disease-free survival, progression-free survival, risk factors, and treatment data.

Main Results:

• CUP patients were significantly older (mean age 65 vs. 41 years) than LNC patients (P=.000).
• An age cutoff of 50-59 years indicated a 50% probability of CUP.
• Previous tumor history was more frequent in CUP patients (P=.045); alcohol/tobacco were not significant risk factors.
• Five-year overall survival for CUP was 77.0%.

Conclusions:

• Patient age and history of prior malignancies are critical for differentiating CUP from LNC.
• In the 50-59 age group, unilateral painless neck swelling has a ~50% chance of being CUP syndrome.
• Panendoscopy with targeted biopsies is essential for early detection and improved outcomes in suspected CUP.