T1 Microscopic Oropharyngeal Carcinoma: Revealing the Unknown Primary Through Diagnostic TORS
F Christopher Holsinger1, Nikita Bedi1, Michael C Topf2
1Division of Head and Neck Surgery, Stanford University, Stanford, California, USA.
Background:
Head and neck squamous cell carcinoma of unknown primary (hnSCCUP) remains a clinical conundrum. Diagnostic transoral robotic surgery (TORS) now routinely identifies occult primary tumors previously undetected by conventional methods. Here we analyze the histopathology of these tumors, demonstrating novel patterns of submucosal spread in predominantly microscopic tumors.
Patients/Methods:
Eighty patients with HPV-mediated hnSCCUP who underwent diagnostic TORS from 2013 to 2022, analyzing tumor histopathology and oncologic outcomes.
Results:
Primary tumors were identified in 66 (83%) patients averaging 6 × 3 mm in diameter. These microscopic primaries produced cervical metastases over 6 times larger, with many exhibiting ribbon-like submucosal spread through lymphoepithelial crypts that evaded conventional detection. Almost all (98%) were T1 tumors; 71% measured < 1 cm. At 38-month follow-up, 96% of patients remained alive without locoregional recurrence.
Conclusions:
Diagnostic TORS reveals that most HPV+ hnSCCUP are actually T1-microscopic oropharyngeal carcinomas, which might constitute a distinct clinical entity requiring new tailored treatment approaches.
Related Concept Videos
01:25Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...
01:21Testing a Claim about Mean: Unknown Population SD
Estimating a population mean requires the samples to be approximately normally distributed. The data should be collected from the randomly selected samples having no sampling bias. There is no specific requirement for sample size. But if the sample size is less than 30, and we don't know the population standard deviation, a different approach is used;...
01:22Estimating Population Mean with Unknown Standard Deviation
William S. Gosset (1876–1937) of the...
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:15Myasthenia Gravis: Diagnostic Tests
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes: