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Summary: The Role of Non-Oropharyngeal Biopsies in Head and Neck Squamous Cell Carcinoma of Unknown Primary: A Systematic Review
Introduction
– This review looks at the use of biopsies in non-oropharyngeal areas for patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP).
Methods
– The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and analyzed articles that included non-oropharyngeal biopsies in HNSCCUP.
Results
– 11 out of 860 articles were included, covering 990 patients.
– No randomized control trials compared survival outcomes between patients who did or did not undergo non-targeted biopsies of non-oropharyngeal sites.
– Retrospective studies showed low yield from random and targeted biopsies in non-oropharyngeal subsites.
– The primary site identified for Epstein-Barr virus (EBV) positive cervical lymph nodes with an unknown primary is mainly the nasopharynx.
– Narrow band imaging (NBI) helps in detecting primaries to target biopsies in non-oropharyngeal subsites.
Conclusions
– It is not appropriate to offer biopsies of clinically and radiologically normal upper aerodigestive tract mucosa at non-oropharyngeal sites.
– Nasopharyngeal biopsies should be offered when cervical node sampling reveals EBV-positive metastasis.
– Where available, NBI should be used to help detect and target biopsies in non-oropharyngeal subsites.
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