Advertisement

Occult Primary with Cervical Secondary-Role of CT Scan and Evaluation Under Anesthesia

  • Ila B. UpadhyaEmail author
  • Jay Suratwala
Original Article
  • 25 Downloads

Abstract

The potential of CT, MRI or both to detect a primary tumor ranges from 9.3 to 23% rising to 60% when suspicious radiological findings direct subsequent endoscopic biopsies (Zhuang et al. in Mol Clin Oncol 2:917–922, 2014). Prospective case Study. To know the sensitivity, specificity accuracy rate and P value of CT scan and upper aero digestive tract endoscopy with palpation of nasopharynx and oropharynx to search the primary site of cancer. 53 patient of occult primary with FNAC proved metastatic squamous cell carcinoma were evaluated to find out the sensitivity, specificity, accuracy rate and P value of imaging study and rigid endoscopic examination of upper aero digestive tract with through palpation of oropharynx, nasopharynx and evaluation under anesthesia (EUA). Punch biopsies were taken from suspicious areas and sent for histopathology examination (HPE). Taking HPE as a gold standard (Ishak et al in Rawal Med J 35:209–213, 2010) sensitivity of both EUA and imaging was found to be 100%, Specificity and diagnostic accuracy of EUA and imaging were 96.77, 83.87, 98.11 and 90.57% respectively. P value was <0.0000001 which is highly significant.

Keywords

Occult Unknown Primary Cervical Cancer Metastasis Endoscopy 

Abbreviations

IDL

Indirect laryngoscopy

CT

Computerized tomography

FNAC

Fine needle aspiration cytology

OPD

Outpatient department

EUA

Evaluation under anesthesia

FNAC

Fine needle aspiration cytology

MCCUP

Metastatic cervical carcinoma from an unknown primary

CUP

Carcinoma of unknown origin

SCC

Squamous cell carcinoma

H&N

Head and neck

MRI

Magnetic resonance imaging

Notes

Compliance with Ethical Standards

Conflict of interest

Dr Ila Upadhya the corresponding author and Dr Jay Suratwala, declare that we do not have any conflict of interest.

References

  1. 1.
    Gleeson M et al (2008) Scott Brown’s otorhinolaryngology head and neck surgery, vol 2-A, 7th edn. Hodder Arnold, LondonCrossRefGoogle Scholar
  2. 2.
    Ali AN et al (2014) A model and nomogram to predict tumor site origin for squamous cell cancer confined to cervical lymph nodes. Cancer 120(22):3469–3476CrossRefGoogle Scholar
  3. 3.
    Zhuang SM et al (2014) Head and neck cancer of unknown primary site. Mol Clin Oncol 2:917–922CrossRefGoogle Scholar
  4. 4.
    Hermans R (2011) Imaging in cervical nodal metastases of unknown primary. Cancer Imaging 11(1A):S9–S14. doi: 10.1102/1470-7330.2011.9004 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ishak AI et al (2010) Role of panendoscopy and biopsy in cervical lymph node metastasis with unknown primary: a tertiary centre experience. Rawal Med J 35:209–213Google Scholar
  6. 6.
    Chaturvedi P, Meyers AD et al (2014) Neck, cervical metastasis, surgery. http://emedicine.medscape.com/article/849611-overview
  7. 7.
    Mukherj SK, Armao D, Joshi VM (2001) Clinical review head & neck November 2001, cervical nodal metastasis in squamous cell carcinoma of the head and neck: what to expect? Head Neck 23(11):995–1005CrossRefGoogle Scholar
  8. 8.
    Zhuang SM, Wu X-F, Li J-J, Zhang G-H et al (2014) Management of lymph node metastases from an unknown primary site to the head and neck. Mol Clin Oncol. doi: 10.3892/mco.2014.361(Review) CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Eldeeb Hany et al (2012) Chemo-radiotherapy in SCC of the neck from unknown primary. Chin J Cancer 13(10):484–490CrossRefGoogle Scholar
  10. 10.
    Calabrese L et al (2005) Neck metastases from an unknown primary. Acta Otorhinolaryngol Ital 25:2–12PubMedPubMedCentralGoogle Scholar
  11. 11.
    Arrangoiz R et al (2014) Metastatic cervical carcinoma from an unknown primary: literature review. Ear Nose Throat J 93(4–5):E1-10. 1-13Google Scholar
  12. 12.
    van Veen SAJM et al (2001) Occult primary tumors of the head and neck. Arch Otolaryngol Head Neck Surg 127(4):406–411. doi: 10.1001/archotol.127.4.406 CrossRefGoogle Scholar
  13. 13.
    Saafan ME et al (2013) Assesment of cervical lymph node in SCC of head and neck. Surg Curr Res 3:4CrossRefGoogle Scholar
  14. 14.
    Joshua W et al (2009) Evolution and efficacy of the modern workup. Arch Otolaryngol Head Neck Surg 135(10):1024–1029CrossRefGoogle Scholar
  15. 15.
    Di Martino Ercole et al (2000) Diagnosis and staging of head and neck cancers. Arch Otolaryngol Head Neck Surg 126:1457–1461CrossRefGoogle Scholar
  16. 16.
    Cianchetti M, Mancuso AA, Amdur RJ et al (2009) Diagnostic evalution of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Laryngoscope 119:2348–2354. doi: 10.1002/lary.20638 CrossRefPubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  1. 1.Department of ENTGovernment Medical CollegeMajuragate, SuratIndia
  2. 2.SuratIndia
  3. 3.SuratIndia

Personalised recommendations