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Indications for Oropharyngeal Biopsy in Head and Neck Squamous Cell Carcinoma of Unknown Primary - A Systematic Review (HNSCCUP)
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  • Rachael Thomas,
  • Noemi Kelemen,
  • Emma Molena,
  • Shane Lester
Rachael Thomas
Glasgow Royal Infirmary
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Noemi Kelemen
Hull University Teaching Hospitals NHS Trust
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Emma Molena
Hull University Teaching Hospitals NHS Trust
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Shane Lester
South Tees Hospitals NHS Foundation Trust

Corresponding Author:[email protected]

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Background Patients presenting with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remain challenging clinical scenarios as large variation exists in practices used to locate the primary. Objective To perform a systematic review of the literature and offer recommendations for oropharyngeal biopsies in HNSCCUP. Method Pubmed, Medline and Embase were searched to identify studies from inception to October 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Results 483 articles were included and screened, 40 studies met the inclusion criteria, including over 3400 patients from the original articles and 1575 patients from 3 meta-analyses. The primary site identification rate following random biopsies or deep tissue biopsies is less than 5% in most studies. The mean detection rate following ipsilateral tonsillectomy is 34%; two pooled analyses indicate that the mean detection rate following tongue base mucosectomy is 64%, with this figure rising when the tonsils are negative. Conclusions High level evidence is lacking, with heterogeneity in the reported studies. Published meta analyses are based on retrospective data. There is little evidence supporting the practice of random/non-directed oropharyngeal biopsies. Available evidence supports palatine tonsillectomy and tongue base mucosectomy compared to deep tissue biopsies.
01 Feb 2023Submitted to Clinical Otolaryngology
29 Mar 2023Assigned to Editor
29 Mar 2023Submission Checks Completed
09 May 2023Reviewer(s) Assigned
17 Jul 2023Review(s) Completed, Editorial Evaluation Pending
03 Aug 2023Editorial Decision: Revise Minor