Diagnostic lymph node extirpation in head and neck CUP syndrome – useful or harmful?

Introduction:

In a proportion of patients with cervical lymph node metastasis no primary can be found even with modern imaging and careful clinical examination (cancer of unknown primary syndrome = CUP syndrome). The ideal diagnostic approach (panendoscopy, diagnostic tonsillectomy, lymph node extirpation, etc.) is still debated on.

Methods:

The clinical data of 79 patients (Median age: 62.2 years; 16 females and 63 males), which have been treated for cervical CUP syndrome (only squamous cell carcinoma) in our hospital were retrospectively analyzed.

Results:

In 11% of patients (n = 9) the primary demarcated in a time period of up to 5.3 years after diagnosis. In the eleven patients which did not receive adjuvant radiotherapy, primary became apparent in 36% (n = 4) within one year. Overall primary was found in 44% (n = 4) in oral cavity, in 33% (n = 3) in oropharynx and in 22% (n = 2) in hypopharynx. Diagnostic lymph node extirpation delayed time until therapeutic neck dissection on average for 21 days. In 55% of patients (with pN2a up to pN2c status) with previous lymph node extirpation, a modified radical neck dissection was required compared to 33% when the surgical site was not operated on.

Conclusions:

In 11% of patients primary demarcated in the course of the disease and was mainly located in the oral cavity and the oropharynx. A diagnostic lymph node extirpation was associated with delayed therapy and higher rate of modified radical neck dissection and indication should therefore considered with caution.

Publication History

Publication Date:
18 April 2018 (online)