Affiliation:
1. Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, England
2. The Institute of Cancer Research, London, England
3. Department of Cellular Pathology, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, England
Abstract
ImportancePatients with suspected head and neck squamous cell carcinoma of unknown primary (HNSCCUP) may undergo tonsillectomy and tongue base mucosectomy (TBM) to help identify clinicoradiologically occult primary disease. It is hypothesized that when these diagnostic specimens are analyzed, conventional histopathological (CH) techniques risk missing small primary tumors that may be hidden in the tissue blocks.ObjectiveTo establish the outcomes of a step serial sectioning (SSS) histopathological technique vs CH when analyzing diagnostic tissue specimens from TBM and tonsillectomy performed for HNSCCUP.Design, Setting, and ParticipantsThe MOSES prospective multicenter noninterventional cohort study was conducted over a 25-month period from November 2019 at secondary and tertiary care ear, nose, and throat departments in the United Kingdom and included adults with clinicoradiologically occult HNSCCUP who were undergoing TBM.InterventionConventional histopathological techniques performed on TBM and tonsillectomy specimens at participating centers, followed by SSS performed at the central laboratory.Main OutcomeIdentification of cancer on central histopathological review of TBM and tonsillectomy specimens.ResultsTissue from 58 eligible patients was analyzed (median [range] age, 58 [47-82] years; 10 women [17%]), with 20 480 sections cut in the laboratory and 4096 sections directly examined by a pathologist (median [range], 64 [28-135] per patient). The overall identification rate for TBM following SSS according to study protocol was 50.0% (95% CI, 37.5%-62.5%) and by subgroups was 42.9% (95% CI, 21.4%-67.4%) when performed following a negative bilateral tonsillectomy, 46.7% (95% CI, 24.8%-69.9%) at the same time as bilateral tonsillectomy, and 57.1% (95% CI, 36.5%-75.5%) following historic tonsillectomy. Conventional histopathological techniques at central review identified 2 undiagnosed primary tumors and revised the diagnosis of 2 other cases (1 nonmalignant and another down staged). Step serial sectioning identified a single additional tumor: an ipsilateral synchronous tongue base tumor for which a contralateral tumor had been identified on CH. Multifocal disease was seen in 5 (8.6%); all were human papillomavirus–related and in the tongue base.Conclusions and RelevanceIn this multicenter cohort study of patients undergoing TBM for HNSCCUP, SSS was associated with added considerable histopathological workload with minimal additional diagnostic benefit. A second opinion for conventional histological techniques may be more beneficial. Synchronous primary disease should be considered when planning diagnostic oropharyngeal surgery for these patients.
Publisher
American Medical Association (AMA)
Subject
Otorhinolaryngology,Surgery
Reference28 articles.
1. Imaging of head and neck cancer with CT, MRI, and US.;Junn;Semin Nucl Med,2021
2. Diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck: ASCO guideline.;Maghami;J Clin Oncol,2020
3. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment.;Marur;Mayo Clin Proc,2016
4. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management.;Lechner;Nat Rev Clin Oncol,2022
5. Human papillomavirus and squamous cell carcinoma of unknown primary in the head and neck region: a comprehensive review on clinical implications.;Larsen;Viruses,2021