Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches
Identifieur interne : 004A92 ( Main/Exploration ); précédent : 004A91; suivant : 004A93Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches
Auteurs : Primož Strojan [Slovénie] ; Alfio Ferlito [Italie] ; Jesus E. Medina [États-Unis] ; Julia A. Woolgar [Royaume-Uni] ; Alessandra Rinaldo [Italie] ; K. Thomas Robbins [États-Unis] ; Johannes J. Fagan [Afrique du Sud] ; William M. Mendenhall [États-Unis] ; Vinidh Paleri [Royaume-Uni] ; Carl E. Silver [États-Unis] ; Kerry D. Olsen [États-Unis] ; June Corry [Australie] ; Carlos Suárez [Espagne] ; Juan P. Rodrigo [Espagne] ; Johannes A. Langendijk [Pays-Bas] ; Kenneth O. Devaney [États-Unis] ; Luiz P. Kowalski [Brésil] ; Dana M. Hartl [France] ; Missak Haigentz Jr [États-Unis] ; Jochen A. Werner [Allemagne] ; Phillip K. Pellitteri [États-Unis] ; Remco De Bree [Pays-Bas] ; Gregory T. Wolf [États-Unis] ; Robert P. Takes [Pays-Bas] ; Eric M. Genden [États-Unis] ; Michael L. Hinni [États-Unis] ; Vanni Mondin [Italie] ; Ashok R. Shaha [États-Unis] ; Leon Barnes [États-Unis]Source :
- Head & Neck [ 1043-3074 ] ; 2013-01.
English descriptors
- KwdEn :
- Adenocarcinoma, Arch otorhinolaryngol, Biopsy, Bree, Carcinoma, Cell carcinoma, Cervical, Cervical lymph node, Cervical lymph node metastases, Cervical lymph node metastasis, Cervical lymph nodes, Cervical metastases, Cervical metastasis, Conventional workup, Core needle biopsy, Cystic, Cystic metastases, Cytokeratin, Diagnostic approaches, Diagnostic evaluation, Diagnostic workup, Differential diagnosis, Distant metastases, Ferlito, Fnab, Head january, Head neck, Human papillomavirus, Imaging, Immunohistochemical, Index cancer, Ipsilateral tonsillectomy, January, Laryngoscope, Lesion, Lymph, Lymph node metastases, Lymph nodes, Lymphoma, Malignancy, Metastasis, Metastatic, Molecular studies, Mucosal, Nasopharyngeal, Nasopharyngeal carcinoma, Nasopharynx, Neck cancer, Neck cancer patients, Neck dissection, Neck malignancies, Neck mass, Neck surgery, Node, Occult, Oncol, Oncology, Open biopsy, Oropharyngeal, Oropharynx, Otolaryngol head neck surg, Panendoscopy, Pathol, Primary site, Primary tumor, Radiation oncology, Squamous, Squamous cell carcinoma, Squamous cell carcinoma metastatic, Strojan, Surg, Suspicious findings, Thyroid transcription, Tissue sections, Tonsillar, Tonsillectomy, Tumor, Unknown origin, Workup.
- Teeft :
- Adenocarcinoma, Arch otorhinolaryngol, Biopsy, Bree, Carcinoma, Cell carcinoma, Cervical, Cervical lymph node, Cervical lymph node metastases, Cervical lymph node metastasis, Cervical lymph nodes, Cervical metastases, Cervical metastasis, Conventional workup, Core needle biopsy, Cystic, Cystic metastases, Cytokeratin, Diagnostic approaches, Diagnostic evaluation, Diagnostic workup, Differential diagnosis, Distant metastases, Ferlito, Fnab, Head january, Head neck, Human papillomavirus, Imaging, Immunohistochemical, Index cancer, Ipsilateral tonsillectomy, January, Laryngoscope, Lesion, Lymph, Lymph node metastases, Lymph nodes, Lymphoma, Malignancy, Metastasis, Metastatic, Molecular studies, Mucosal, Nasopharyngeal, Nasopharyngeal carcinoma, Nasopharynx, Neck cancer, Neck cancer patients, Neck dissection, Neck malignancies, Neck mass, Neck surgery, Node, Occult, Oncol, Oncology, Open biopsy, Oropharyngeal, Oropharynx, Otolaryngol head neck surg, Panendoscopy, Pathol, Primary site, Primary tumor, Radiation oncology, Squamous, Squamous cell carcinoma, Squamous cell carcinoma metastatic, Strojan, Surg, Suspicious findings, Thyroid transcription, Tissue sections, Tonsillar, Tonsillectomy, Tumor, Unknown origin, Workup.
Abstract
In an era of advanced diagnostics, metastasis to cervical lymph nodes from an occult primary tumor is a rare clinical entity and accounts for approximately 3% of head and neck malignancies. Histologically, two thirds of cases are squamous cell carcinomas (SCCs), with other tissue types less common in the neck. With modern imaging and tissue examinations, a primary tumor initially undetected on physical examination is revealed in >50% of patients and the site of the index primary can be predicted with a high level of probability. In the present review, the range and limitations of diagnostic procedures are summarized and the optimal diagnostic workup is proposed. Initial preferred diagnostic procedures are a fine‐needle aspiration biopsy (FNAB) and imaging. This allows directed surgical biopsy (such as tonsillectomy), based on the preliminary findings, and prevents misinterpretation of postsurgical images. When no primary lesion is suggested after imaging and panendoscopy, and for patients without a history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus (HPV) and/or Epstein–Barr virus (EBV) is important. Head Neck, 2013
Url:
DOI: 10.1002/hed.21898
Affiliations:
- Afrique du Sud, Allemagne, Australie, Brésil, Espagne, France, Italie, Pays-Bas, Royaume-Uni, Slovénie, États-Unis
- Arizona, District de Giessen, Floride, Groningue (province), Gueldre, Hesse (Land), Hollande-Septentrionale, Illinois, Michigan, Minnesota, Oklahoma, Pennsylvanie, État de New York, État de São Paulo, Île-de-France
- Amsterdam, Groningue, Marbourg, Nimègue, Paris, São Paulo
Links toward previous steps (curation, corpus...)
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- to stream Main, to step Curation: 004A92
Le document en format XML
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A review of diagnostic approaches<ref type="note" target="#fn1"></ref></title><author><name sortKey="Strojan, Primoz" sort="Strojan, Primoz" uniqKey="Strojan P" first="Primož" last="Strojan">Primož Strojan</name><affiliation wicri:level="1"><country xml:lang="fr">Slovénie</country><wicri:regionArea>Department of Radiation Oncology, Institute of Oncology, Ljubljana</wicri:regionArea><wicri:noRegion>Ljubljana</wicri:noRegion></affiliation></author><author><name sortKey="Ferlito, Alfio" sort="Ferlito, Alfio" uniqKey="Ferlito A" first="Alfio" last="Ferlito">Alfio Ferlito</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>ENT Clinic, University of Udine, Udine</wicri:regionArea><wicri:noRegion>Udine</wicri:noRegion></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Italie</country></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Correspondence address: ENT Clinic, University of Udine, Udine</wicri:regionArea><wicri:noRegion>Udine</wicri:noRegion></affiliation></author><author><name sortKey="Medina, Jesus E" sort="Medina, Jesus E" uniqKey="Medina J" first="Jesus E." last="Medina">Jesus E. Medina</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Oklahoma</region></placeName><wicri:cityArea>Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City</wicri:cityArea></affiliation></author><author><name sortKey="Woolgar, Julia A" sort="Woolgar, Julia A" uniqKey="Woolgar J" first="Julia A." last="Woolgar">Julia A. Woolgar</name><affiliation wicri:level="1"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Cellular Pathology, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL</wicri:regionArea><wicri:noRegion>L9 7AL</wicri:noRegion></affiliation></author><author><name sortKey="Rinaldo, Alessandra" sort="Rinaldo, Alessandra" uniqKey="Rinaldo A" first="Alessandra" last="Rinaldo">Alessandra Rinaldo</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>ENT Clinic, University of Udine, Udine</wicri:regionArea><wicri:noRegion>Udine</wicri:noRegion></affiliation></author><author><name sortKey="Robbins, K Thomas" sort="Robbins, K Thomas" uniqKey="Robbins K" first="K. Thomas" last="Robbins">K. Thomas Robbins</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Illinois</region></placeName><wicri:cityArea>Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield</wicri:cityArea></affiliation></author><author><name sortKey="Fagan, Johannes J" sort="Fagan, Johannes J" uniqKey="Fagan J" first="Johannes J." last="Fagan">Johannes J. Fagan</name><affiliation wicri:level="1"><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Division of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Mendenhall, William M" sort="Mendenhall, William M" uniqKey="Mendenhall W" first="William M." last="Mendenhall">William M. Mendenhall</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Floride</region></placeName><wicri:cityArea>Department of Radiation Oncology, University of Florida, Gainesville</wicri:cityArea></affiliation></author><author><name sortKey="Paleri, Vinidh" sort="Paleri, Vinidh" uniqKey="Paleri V" first="Vinidh" last="Paleri">Vinidh Paleri</name><affiliation wicri:level="1"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Otolaryngology–Head and Neck Surgery, Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Silver, Carl E" sort="Silver, Carl E" uniqKey="Silver C" first="Carl E." last="Silver">Carl E. Silver</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx</wicri:cityArea></affiliation></author><author><name sortKey="Olsen, Kerry D" sort="Olsen, Kerry D" uniqKey="Olsen K" first="Kerry D." last="Olsen">Kerry D. Olsen</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Department of Otorhinolaryngology, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Corry, June" sort="Corry, June" uniqKey="Corry J" first="June" last="Corry">June Corry</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria</wicri:regionArea><wicri:noRegion>Victoria</wicri:noRegion></affiliation></author><author><name sortKey="Suarez, Carlos" sort="Suarez, Carlos" uniqKey="Suarez C" first="Carlos" last="Suárez">Carlos Suárez</name><affiliation wicri:level="1"><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo</wicri:regionArea><wicri:noRegion>Oviedo</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Espagne</country><wicri:regionArea>Instituto Universitario de Oncología del Principado de Asturias, Oviedo</wicri:regionArea><wicri:noRegion>Oviedo</wicri:noRegion></affiliation></author><author><name sortKey="Rodrigo, Juan P" sort="Rodrigo, Juan P" uniqKey="Rodrigo J" first="Juan P." last="Rodrigo">Juan P. Rodrigo</name><affiliation wicri:level="1"><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo</wicri:regionArea><wicri:noRegion>Oviedo</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Espagne</country><wicri:regionArea>Instituto Universitario de Oncología del Principado de Asturias, Oviedo</wicri:regionArea><wicri:noRegion>Oviedo</wicri:noRegion></affiliation></author><author><name sortKey="Langendijk, Johannes A" sort="Langendijk, Johannes A" uniqKey="Langendijk J" first="Johannes A." last="Langendijk">Johannes A. Langendijk</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Devaney, Kenneth O" sort="Devaney, Kenneth O" uniqKey="Devaney K" first="Kenneth O." last="Devaney">Kenneth O. Devaney</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Pathology, Allegiance Health, Jackson</wicri:cityArea></affiliation></author><author><name sortKey="Kowalski, Luiz P" sort="Kowalski, Luiz P" uniqKey="Kowalski L" first="Luiz P." last="Kowalski">Luiz P. Kowalski</name><affiliation wicri:level="3"><country xml:lang="fr">Brésil</country><wicri:regionArea>Department Otorhinolaryngology–Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo</wicri:regionArea><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Hartl, Dana M" sort="Hartl, Dana M" uniqKey="Hartl D" first="Dana M." last="Hartl">Dana M. Hartl</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Department of Otolaryngology–Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex</wicri:regionArea><wicri:noRegion>Villejuif Cedex</wicri:noRegion><wicri:noRegion>Villejuif Cedex</wicri:noRegion></affiliation><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Haigentz Jr, Missak" sort="Haigentz Jr, Missak" uniqKey="Haigentz Jr M" first="Missak" last="Haigentz Jr">Missak Haigentz Jr</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx</wicri:cityArea></affiliation></author><author><name sortKey="Werner, Jochen A" sort="Werner, Jochen A" uniqKey="Werner J" first="Jochen A." last="Werner">Jochen A. Werner</name><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Otolaryngology–Head and Neck Surgery, Philipp University, Marburg</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Giessen</region><settlement type="city">Marbourg</settlement></placeName></affiliation></author><author><name sortKey="Pellitteri, Phillip K" sort="Pellitteri, Phillip K" uniqKey="Pellitteri P" first="Phillip K." last="Pellitteri">Phillip K. Pellitteri</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology–Head and Neck Surgery, Geisinger Medical Center, Danville</wicri:cityArea></affiliation></author><author><name sortKey="De Bree, Remco" sort="De Bree, Remco" uniqKey="De Bree R" first="Remco" last="De Bree">Remco De Bree</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Otolaryngology–Head and Neck Surgery, VU University Medical Center, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Wolf, Gregory T" sort="Wolf, Gregory T" uniqKey="Wolf G" first="Gregory T." last="Wolf">Gregory T. Wolf</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Takes, Robert P" sort="Takes, Robert P" uniqKey="Takes R" first="Robert P." last="Takes">Robert P. Takes</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Otolaryngology–Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Genden, Eric M" sort="Genden, Eric M" uniqKey="Genden E" first="Eric M." last="Genden">Eric M. Genden</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Otolaryngology–Head and Neck Surgery, The Mount Sinai Medical Center, New York</wicri:cityArea></affiliation></author><author><name sortKey="Hinni, Michael L" sort="Hinni, Michael L" uniqKey="Hinni M" first="Michael L." last="Hinni">Michael L. Hinni</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arizona</region></placeName><wicri:cityArea>Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Phoenix</wicri:cityArea></affiliation></author><author><name sortKey="Mondin, Vanni" sort="Mondin, Vanni" uniqKey="Mondin V" first="Vanni" last="Mondin">Vanni Mondin</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>ENT Clinic, University of Udine, Udine</wicri:regionArea><wicri:noRegion>Udine</wicri:noRegion></affiliation></author><author><name sortKey="Shaha, Ashok R" sort="Shaha, Ashok R" uniqKey="Shaha A" first="Ashok R." last="Shaha">Ashok R. Shaha</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Head and Neck Service, Memorial Sloan–Kettering Cancer Center, New York</wicri:cityArea></affiliation></author><author><name sortKey="Barnes, Leon" sort="Barnes, Leon" uniqKey="Barnes L" first="Leon" last="Barnes">Leon Barnes</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh</wicri:cityArea></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Head & Neck</title><title level="j" type="alt">HEAD AND NECK</title><idno type="ISSN">1043-3074</idno><idno type="eISSN">1097-0347</idno><imprint><biblScope unit="vol">35</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="123">123</biblScope><biblScope unit="page" to="132">132</biblScope><biblScope unit="page-count">10</biblScope><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2013-01">2013-01</date></imprint><idno type="ISSN">1043-3074</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1043-3074</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adenocarcinoma</term><term>Arch otorhinolaryngol</term><term>Biopsy</term><term>Bree</term><term>Carcinoma</term><term>Cell carcinoma</term><term>Cervical</term><term>Cervical lymph node</term><term>Cervical lymph node metastases</term><term>Cervical lymph node metastasis</term><term>Cervical lymph nodes</term><term>Cervical metastases</term><term>Cervical metastasis</term><term>Conventional workup</term><term>Core needle biopsy</term><term>Cystic</term><term>Cystic metastases</term><term>Cytokeratin</term><term>Diagnostic approaches</term><term>Diagnostic evaluation</term><term>Diagnostic workup</term><term>Differential diagnosis</term><term>Distant metastases</term><term>Ferlito</term><term>Fnab</term><term>Head january</term><term>Head neck</term><term>Human papillomavirus</term><term>Imaging</term><term>Immunohistochemical</term><term>Index cancer</term><term>Ipsilateral tonsillectomy</term><term>January</term><term>Laryngoscope</term><term>Lesion</term><term>Lymph</term><term>Lymph node metastases</term><term>Lymph nodes</term><term>Lymphoma</term><term>Malignancy</term><term>Metastasis</term><term>Metastatic</term><term>Molecular studies</term><term>Mucosal</term><term>Nasopharyngeal</term><term>Nasopharyngeal carcinoma</term><term>Nasopharynx</term><term>Neck cancer</term><term>Neck cancer patients</term><term>Neck dissection</term><term>Neck malignancies</term><term>Neck mass</term><term>Neck surgery</term><term>Node</term><term>Occult</term><term>Oncol</term><term>Oncology</term><term>Open biopsy</term><term>Oropharyngeal</term><term>Oropharynx</term><term>Otolaryngol head neck surg</term><term>Panendoscopy</term><term>Pathol</term><term>Primary site</term><term>Primary tumor</term><term>Radiation oncology</term><term>Squamous</term><term>Squamous cell carcinoma</term><term>Squamous cell carcinoma metastatic</term><term>Strojan</term><term>Surg</term><term>Suspicious findings</term><term>Thyroid transcription</term><term>Tissue sections</term><term>Tonsillar</term><term>Tonsillectomy</term><term>Tumor</term><term>Unknown origin</term><term>Workup</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Adenocarcinoma</term><term>Arch otorhinolaryngol</term><term>Biopsy</term><term>Bree</term><term>Carcinoma</term><term>Cell carcinoma</term><term>Cervical</term><term>Cervical lymph node</term><term>Cervical lymph node metastases</term><term>Cervical lymph node metastasis</term><term>Cervical lymph nodes</term><term>Cervical metastases</term><term>Cervical metastasis</term><term>Conventional workup</term><term>Core needle biopsy</term><term>Cystic</term><term>Cystic metastases</term><term>Cytokeratin</term><term>Diagnostic approaches</term><term>Diagnostic evaluation</term><term>Diagnostic workup</term><term>Differential diagnosis</term><term>Distant metastases</term><term>Ferlito</term><term>Fnab</term><term>Head january</term><term>Head neck</term><term>Human papillomavirus</term><term>Imaging</term><term>Immunohistochemical</term><term>Index cancer</term><term>Ipsilateral tonsillectomy</term><term>January</term><term>Laryngoscope</term><term>Lesion</term><term>Lymph</term><term>Lymph node metastases</term><term>Lymph nodes</term><term>Lymphoma</term><term>Malignancy</term><term>Metastasis</term><term>Metastatic</term><term>Molecular studies</term><term>Mucosal</term><term>Nasopharyngeal</term><term>Nasopharyngeal carcinoma</term><term>Nasopharynx</term><term>Neck cancer</term><term>Neck cancer patients</term><term>Neck dissection</term><term>Neck malignancies</term><term>Neck mass</term><term>Neck surgery</term><term>Node</term><term>Occult</term><term>Oncol</term><term>Oncology</term><term>Open biopsy</term><term>Oropharyngeal</term><term>Oropharynx</term><term>Otolaryngol head neck surg</term><term>Panendoscopy</term><term>Pathol</term><term>Primary site</term><term>Primary tumor</term><term>Radiation oncology</term><term>Squamous</term><term>Squamous cell carcinoma</term><term>Squamous cell carcinoma metastatic</term><term>Strojan</term><term>Surg</term><term>Suspicious findings</term><term>Thyroid transcription</term><term>Tissue sections</term><term>Tonsillar</term><term>Tonsillectomy</term><term>Tumor</term><term>Unknown origin</term><term>Workup</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">In an era of advanced diagnostics, metastasis to cervical lymph nodes from an occult primary tumor is a rare clinical entity and accounts for approximately 3% of head and neck malignancies. Histologically, two thirds of cases are squamous cell carcinomas (SCCs), with other tissue types less common in the neck. With modern imaging and tissue examinations, a primary tumor initially undetected on physical examination is revealed in >50% of patients and the site of the index primary can be predicted with a high level of probability. In the present review, the range and limitations of diagnostic procedures are summarized and the optimal diagnostic workup is proposed. Initial preferred diagnostic procedures are a fine‐needle aspiration biopsy (FNAB) and imaging. This allows directed surgical biopsy (such as tonsillectomy), based on the preliminary findings, and prevents misinterpretation of postsurgical images. When no primary lesion is suggested after imaging and panendoscopy, and for patients without a history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus (HPV) and/or Epstein–Barr virus (EBV) is important. Head Neck, 2013</div></front></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Allemagne</li><li>Australie</li><li>Brésil</li><li>Espagne</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Slovénie</li><li>États-Unis</li></country><region><li>Arizona</li><li>District de Giessen</li><li>Floride</li><li>Groningue (province)</li><li>Gueldre</li><li>Hesse (Land)</li><li>Hollande-Septentrionale</li><li>Illinois</li><li>Michigan</li><li>Minnesota</li><li>Oklahoma</li><li>Pennsylvanie</li><li>État de New York</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Amsterdam</li><li>Groningue</li><li>Marbourg</li><li>Nimègue</li><li>Paris</li><li>São Paulo</li></settlement></list><tree><country name="Slovénie"><noRegion><name sortKey="Strojan, Primoz" sort="Strojan, Primoz" uniqKey="Strojan P" first="Primož" last="Strojan">Primož Strojan</name></noRegion></country><country name="Italie"><noRegion><name sortKey="Ferlito, Alfio" sort="Ferlito, Alfio" uniqKey="Ferlito A" first="Alfio" last="Ferlito">Alfio Ferlito</name></noRegion><name sortKey="Ferlito, Alfio" sort="Ferlito, Alfio" uniqKey="Ferlito A" first="Alfio" last="Ferlito">Alfio Ferlito</name><name sortKey="Ferlito, Alfio" sort="Ferlito, Alfio" uniqKey="Ferlito A" first="Alfio" last="Ferlito">Alfio Ferlito</name><name sortKey="Mondin, Vanni" sort="Mondin, Vanni" uniqKey="Mondin V" first="Vanni" last="Mondin">Vanni Mondin</name><name sortKey="Rinaldo, Alessandra" sort="Rinaldo, Alessandra" uniqKey="Rinaldo A" first="Alessandra" last="Rinaldo">Alessandra Rinaldo</name></country><country name="États-Unis"><region name="Oklahoma"><name sortKey="Medina, Jesus E" sort="Medina, Jesus E" uniqKey="Medina J" first="Jesus E." last="Medina">Jesus E. Medina</name></region><name sortKey="Barnes, Leon" sort="Barnes, Leon" uniqKey="Barnes L" first="Leon" last="Barnes">Leon Barnes</name><name sortKey="Devaney, Kenneth O" sort="Devaney, Kenneth O" uniqKey="Devaney K" first="Kenneth O." last="Devaney">Kenneth O. Devaney</name><name sortKey="Genden, Eric M" sort="Genden, Eric M" uniqKey="Genden E" first="Eric M." last="Genden">Eric M. Genden</name><name sortKey="Haigentz Jr, Missak" sort="Haigentz Jr, Missak" uniqKey="Haigentz Jr M" first="Missak" last="Haigentz Jr">Missak Haigentz Jr</name><name sortKey="Hinni, Michael L" sort="Hinni, Michael L" uniqKey="Hinni M" first="Michael L." last="Hinni">Michael L. Hinni</name><name sortKey="Mendenhall, William M" sort="Mendenhall, William M" uniqKey="Mendenhall W" first="William M." last="Mendenhall">William M. Mendenhall</name><name sortKey="Olsen, Kerry D" sort="Olsen, Kerry D" uniqKey="Olsen K" first="Kerry D." last="Olsen">Kerry D. Olsen</name><name sortKey="Pellitteri, Phillip K" sort="Pellitteri, Phillip K" uniqKey="Pellitteri P" first="Phillip K." last="Pellitteri">Phillip K. Pellitteri</name><name sortKey="Robbins, K Thomas" sort="Robbins, K Thomas" uniqKey="Robbins K" first="K. Thomas" last="Robbins">K. Thomas Robbins</name><name sortKey="Shaha, Ashok R" sort="Shaha, Ashok R" uniqKey="Shaha A" first="Ashok R." last="Shaha">Ashok R. Shaha</name><name sortKey="Silver, Carl E" sort="Silver, Carl E" uniqKey="Silver C" first="Carl E." last="Silver">Carl E. Silver</name><name sortKey="Wolf, Gregory T" sort="Wolf, Gregory T" uniqKey="Wolf G" first="Gregory T." last="Wolf">Gregory T. Wolf</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Woolgar, Julia A" sort="Woolgar, Julia A" uniqKey="Woolgar J" first="Julia A." last="Woolgar">Julia A. Woolgar</name></noRegion><name sortKey="Paleri, Vinidh" sort="Paleri, Vinidh" uniqKey="Paleri V" first="Vinidh" last="Paleri">Vinidh Paleri</name></country><country name="Afrique du Sud"><noRegion><name sortKey="Fagan, Johannes J" sort="Fagan, Johannes J" uniqKey="Fagan J" first="Johannes J." last="Fagan">Johannes J. Fagan</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Corry, June" sort="Corry, June" uniqKey="Corry J" first="June" last="Corry">June Corry</name></noRegion></country><country name="Espagne"><noRegion><name sortKey="Suarez, Carlos" sort="Suarez, Carlos" uniqKey="Suarez C" first="Carlos" last="Suárez">Carlos Suárez</name></noRegion><name sortKey="Rodrigo, Juan P" sort="Rodrigo, Juan P" uniqKey="Rodrigo J" first="Juan P." last="Rodrigo">Juan P. Rodrigo</name><name sortKey="Rodrigo, Juan P" sort="Rodrigo, Juan P" uniqKey="Rodrigo J" first="Juan P." last="Rodrigo">Juan P. Rodrigo</name><name sortKey="Suarez, Carlos" sort="Suarez, Carlos" uniqKey="Suarez C" first="Carlos" last="Suárez">Carlos Suárez</name></country><country name="Pays-Bas"><region name="Groningue (province)"><name sortKey="Langendijk, Johannes A" sort="Langendijk, Johannes A" uniqKey="Langendijk J" first="Johannes A." last="Langendijk">Johannes A. Langendijk</name></region><name sortKey="De Bree, Remco" sort="De Bree, Remco" uniqKey="De Bree R" first="Remco" last="De Bree">Remco De Bree</name><name sortKey="Takes, Robert P" sort="Takes, Robert P" uniqKey="Takes R" first="Robert P." last="Takes">Robert P. Takes</name></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Kowalski, Luiz P" sort="Kowalski, Luiz P" uniqKey="Kowalski L" first="Luiz P." last="Kowalski">Luiz P. Kowalski</name></region></country><country name="France"><noRegion><name sortKey="Hartl, Dana M" sort="Hartl, Dana M" uniqKey="Hartl D" first="Dana M." last="Hartl">Dana M. Hartl</name></noRegion><name sortKey="Hartl, Dana M" sort="Hartl, Dana M" uniqKey="Hartl D" first="Dana M." last="Hartl">Dana M. Hartl</name></country><country name="Allemagne"><region name="Hesse (Land)"><name sortKey="Werner, Jochen A" sort="Werner, Jochen A" uniqKey="Werner J" first="Jochen A." last="Werner">Jochen A. Werner</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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