外科医生进行术中经口超声检查可提高人乳头瘤病毒阳性的不明原发灶头颈部癌的检出率。

Surgeon-performed intraoperative transoral ultrasound improves the detection of human papillomavirus-positive head and neck cancers of unknown primary.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital - Rigshospitalet, 2100 Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark.

出版信息

Oral Oncol. 2024 Dec;159:107073. doi: 10.1016/j.oraloncology.2024.107073. Epub 2024 Oct 14.

DOI:10.1016/j.oraloncology.2024.107073

PMID:39406014

Abstract

BACKGROUND

Squamous cell carcinomas of unknown primary (SCCUP) are often Human Papillomavirus (HPV)-positive. Due to their small size, extensive surgical workup is required to locate the primary tumors. High-frequency transoral ultrasound (US) may provide improved visualization of these small tumors. Our study aimed to explore whether surgeon-performed intraoperative transoral US for patients with HPV-positiveSCCUP could improve primary tumor detection during panendoscopy.

METHODS

This was a single-center, prospective diagnostic study including patients undergoing panendoscopy under general anesthesia with HPV-positive SCCUP. Preoperative MRIs, PET/CTs, and HPV DNA-testing of lymph node metastases were performed in all patients. Intraoperative transoral US was performed prior to panendoscopy. Frozen section biopsies were performed unblinded to US results, and transoral US-guided biopsies were attempted if initial biopsies were negative. Final histopathology was obtained with palatine- and/or lingual tonsillectomy if frozen section was negative. The main outcome was the primary tumor detection rate with intraoperative transoral US and panendoscopy.

RESULTS

Thirty patients were included: 24 (80 %) were men, and the median age was 60 years [range 35-79 years]. Twenty-nine primary tumors (97 %) were confirmed; 18 (62 %) and 10 (34 %) in the lingual- and palatine tonsils, respectively, and one (3 %) in the posterior oropharynx. Transoral US had a significantly higher sensitivity than panendoscopy to locate the primary tumor (93 % vs 76 %, p = 0.02), and significantly higher than pre-operative PET/CT (62 %, p = 0.002), CT (45 %, p < 0.001), and MRI (28 %, p < 0.001).

CONCLUSIONS

Intraoperative transoral US during panendoscopy is a promising diagnostic tool that may improve the detection of HPV-positive SCCUP.

摘要

背景

不明原发灶的鳞状细胞癌（SCCUP）通常为人类乳头瘤病毒（HPV）阳性。由于其体积小，需要进行广泛的外科检查以定位原发肿瘤。高频经口超声（US）可能会提高这些小肿瘤的可视化程度。我们的研究旨在探讨对于 HPV 阳性 SCCUP 患者，在泛内镜检查过程中由外科医生进行术中经口 US 是否可以提高原发肿瘤的检出率。

方法

这是一项单中心前瞻性诊断研究，纳入了在全身麻醉下接受 HPV 阳性 SCCUP 泛内镜检查的患者。所有患者均进行了术前 MRI、PET/CT 和淋巴结转移 HPV DNA 检测。在泛内镜检查之前进行术中经口 US。在未观察 US 结果的情况下进行冷冻切片活检，如果初次活检为阴性，则尝试进行经口 US 引导下的活检。如果冷冻切片为阴性，则进行腭扁桃体和/或舌扁桃体切除术以获得最终的组织病理学结果。主要结局是术中经口 US 和泛内镜检查的原发肿瘤检出率。

结果

共纳入 30 例患者：24 例（80%）为男性，中位年龄为 60 岁[范围 35-79 岁]。29 例（97%）原发肿瘤得到证实；18 例（62%）位于舌扁桃体，10 例（34%）位于腭扁桃体，1 例（3%）位于后口咽。与泛内镜检查相比，经口 US 定位原发肿瘤的敏感性显著更高（93%比 76%，p=0.02），显著高于术前 PET/CT（62%，p=0.002）、CT（45%，p<0.001）和 MRI（28%，p<0.001）。