Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States.
Oral Oncol. 2014 Jul;50(7):640-5. doi: 10.1016/j.oraloncology.2014.03.015. Epub 2014 May 10.
Although human papillomavirus detection in cervical lymph nodes of head and neck squamous cell cancers (HNSCC) of unknown primary site (UP) is indicative of a primary tumor of the oropharynx (OP), localization can remain elusive. Therefore, we investigated ultrasonography (US) for the identification of the primary tumor.
Eligible cases had HNSCC of UP after evaluation by a head and neck surgical oncologist. Controls were healthy volunteers. Transcervical and intraoral ultrasonography was performed by a standard protocol using convex (3.75-6.0 MHz and 5-7.5 MHz) transducers. US findings were compared with operative examination (exam under anesthesia, direct laryngoscopy) and biopsies. The primary outcome of interest was the presence or absence of a lesion on US.
10 cases and 20 controls were enrolled. PET/CT scans were negative/nonspecific (9), or suspicious (1) for a primary lesion. On US, predominantly hypoechoic (9 of 10) lesions were visualized consistent with base of tongue (n=7) or tonsil (n=3) primary tumors. On operative examination, 5 of 10 were appreciated. Two additional primaries were confirmed with biopsies "directed" by preoperative US. This represents an overall diagnostic rate of 70%, which is 20% higher than our detection rate for 2008-2010. The three cases in which a suspicious lesion was visualized on US, yet remained UP despite further interventions, could represent false positives, misclassification or operator variability. No lesions were suspected among the controls.
Ultrasound has promise for detection of UPs of the OP and therefore warrants further investigation.
虽然人乳头瘤病毒（HPV）在头颈部鳞状细胞癌（HNSCC）颈淋巴结中的检测提示口咽（OP）原发性肿瘤，但肿瘤定位仍难以确定。因此，我们研究了超声（US）在识别原发性肿瘤中的作用。
符合条件的病例为头颈部外科肿瘤学家评估后的头颈部未明确来源（UP）的 HNSCC；对照组为健康志愿者。采用标准方案进行经颈和经口超声检查，使用凸阵（3.75-6.0 MHz 和 5-7.5 MHz）探头。将 US 检查结果与手术检查（麻醉下检查、直接喉镜检查）和活检进行比较。主要观察指标为 US 上是否存在病变。
共纳入 10 例病例和 20 例对照。PET/CT 扫描结果为阴性/非特异性（9 例）或可疑（1 例），提示存在原发性病变。US 上可见 10 例中 9 例为低回声（9/10）病变，符合舌根（n=7）或扁桃体（n=3）原发性肿瘤。手术检查中，10 例中可评估 5 例。术前 US 引导的活检进一步证实了另外 2 个原发性肿瘤。总体诊断率为 70%，高于 2008-2010 年的检测率 20%。US 上可见可疑病变，但进一步干预后仍为 UP 的 3 例，可能为假阳性、错误分类或操作者差异。对照组未怀疑有病变。
超声对 OP 原发性肿瘤的检测具有一定的前景，因此值得进一步研究。
