Abstract
To assess the exact role of high-risk HPV testing in patients of carcinoma unknown primary with secondary metastasis to the neck who underwent TORS and neck dissection for identification of the primary site.
A prospective study was carried out at a tertiary care centre over one year. Patients with unilateral neck swelling, which was cytologically proven squamous cell carcinoma neck metastasis, were included in the study. After clinicopathological evaluation, they underwent TORS-assisted ipsilateral radical tonsillectomy, tongue base mucosal wedge biopsy for primary site identification, and ipsilateral neck dissection. They underwent HPV RNA ISH from the tonsil, the base of the tongue and blood. They also underwent HPV DNA testing from the blood. P16 was done in the base of tongue, tonsil, and lymph node specimens.
In the study cohort of 18 patients who underwent ipsilateral radical tonsillectomy, mucosal tongue base wedge biopsy and neck dissection, p16 positivity was isolated in 5.56%, 0% and 2.78% of patients, respectively. (n = 1/18, 0/18, 5/18). Interestingly, HPV E7 mRNA expression was absent in the tonsil /base of tongue specimens, but metastatic lymph nodes displayed expression in 11.11%. HPV DNA was undetected in all analysed tissues and patients’ blood.
In the Indian subcontinent, it is not essential to do detailed high-risk HPV analysis in cases of carcinoma unknown primary with secondary metastasis to the neck.
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References
Nandi S, Mandal A, Chhebbi M (2021) The prevalence and clinicopathological correlation of human papillomavirus in head and neck squamous cell carcinoma in India: a systematic review article. Cancer Treat Res Commun 26:100301
Larsen MHH, Channir HI, von Buchwald C (2021) Human papillomavirus and squamous cell carcinoma of unknown primary in the head and neck region: a comprehensive review on clinical implications. Viruses 13(7):1297
Jensen DH, Hedback N, Specht L, Hogdall E, Andersen E, Therkildsen MH et al (2014) Human papillomavirus in head and neck squamous cell carcinoma of unknown primary is a common event and a strong predictor of survival. PLoS ONE 9:e110456
Kato MG, Baek CH, Chaturvedi P, Gallagher R, Kowalski LP, Leemans CR et al (2020) Update on oral and oropharyngeal cancer staging - International perspectives. World J Otorhinolaryngol Head Neck Surg 6(1):66–75
Sannigrahi MK, Singh V, Sharma R, Panda NK, Radotra BD, Khullar M (2016) Detection of active human papilloma virus-16 in head and neck cancers of Asian North Indian patients. Oral Dis 22:62–68
Boscolo-Rizzo P, Schroeder L, Romeo S, Pawlita M (2015) The prevalence of human papillomavirus in squamous cell carcinoma of unknown primary site metastatic to neck lymph nodes: a systematic review. Clin Exp Metastasis 32(8):835–845
Park GC, Lee M, Roh JL, Yu MS, Choi SH, Nam SY et al (2012) Human papillomavirus and p16 detection in cervical lymph node metastases from an unknown primary tumor. Oral Oncol 48(12):1250–1256
Escobar Gil T, HenaoRincón MA, Laverde J, Echavarria Cross A, Duque CS (2023) Understanding the role of human papillomavirus in head and neck cancer of unknown primary: a systematic review. Cureus 15(5):e39643
Compton AM, Moore-Medlin T, Herman-Ferdinandez L, Clark C, Caldito GC, Wang XI et al (2011) Human papillomavirus in metastatic lymph nodes from unknown primary head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 145(1):51–57
Kobayashi K, Saito Y, Omura G, Ando M, Sakamoto T, Yamasoba T et al (2014) Clinical features of human papilloma virus-related head and neck squamous cell carcinoma of an unknown primary site. ORL J Otorhinolaryngol Relat Spec 76(3):137–146
Chettuvatti K, Panda NK, Bakshi JB, Verma RK, Nayak GR, Goel N et al (2024) The role of trans oral robotic surgery in the carcinoma of unknown primary: a new evidence in the horizon? Indian J Otolaryngol Head Neck Surg
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KC, NKP, and AM collected the data. KC, NKP, AM, JBB and AD prepared the manuscript. KC, NKP, AM and AD revised the manuscript. KC, NKP, JBB and AM did the final editing and submission.
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Chettuvatti, K., Panda, N.K., Mittal, A. et al. Decoding the Enigma: Harnessing HPV Testing for the Precision Care in Carcinoma Unknown Primary with Secondary Metastasis to the Neck in North Indian Population Undergoing TORS for Primary Identification. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04628-5
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DOI: https://doi.org/10.1007/s12070-024-04628-5