Role of upper respiratory tract fibroscopy in patients with cervical lymph node metastases from squamous-cell carcinoma without the primary tumor found

Background. The detection of primary tumor in patients with cervical lymph node metastases without the primary tumor found is very important, because its location often determines the treatment strategy. The study objective is to analyze the capabilities of upper respiratory tract fibroscopy for the detection of primary tumor in patients with cervical lymph node metastases from squamous-cell carcinoma without the primary tumor found.

Materials in methods. A total of 70 patients with cervical lymph node metastases without the primary tumor found, in whom cytological examination of biopsy specimens collected from cervical lymph nodes revealed squamous-cell carcinoma, underwent upper respiratory tract fibroscopy in N.N. Blokhin National Medical Research Center of Oncology between January 2017 and May 2020.

Results. In 24 out of 70 patients, fibroscopy helped to identify the primary tumor and collect biomaterial for morphological examination. Twelve patients were found to have oropharyngeal cancer; ten patients were diagnosed with nasopharyngeal cancer; and 2 patients had laryngopharyngeal cancer. Fifteen out of 24 patients had tumors less than 1.2 cm.

Conclusion. Upper respiratory tract fibroscopy is a highly effective method for detecting small asymptomatic tumors. It can be recommended for the examination of patients with metastases from squamous-cell carcinoma without the primary tumor found, if the primary tumor is believed to be located in the upper respiratory tract

1. Cancer without detected primary focus. In: Minimal clinical recommendations of the European Society for Medical Oncology (ESMO). Moscow: Publ. group of the N.N. Blokhin ROSC, 2010. Pр. 348–353. (In Russ.).

2. Pavlidis N., Fizazi K. Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol 2009;69(3):271–8. DOI: 10.1016/j.critrevonc.2008.09.005.

3. Pavlidis N., Pentheroudakis G. Cancer of unknown primary site: 20 questions to be answered. Ann Oncol 2010;21 Suppl 7:vii303–7. DOI: 10.1093/annonc/mdq278.

4. Komarov I.G., Sletina S.Yu. Metastases of malignant tumor of unknown primary. Onkoginekologiya = Gynecologic Oncology 2015;(2):50–8. (In Russ.).

5. Bernal M.P., Cazar E.L., Estevez R.A. et al. Tumor primitivo desconocido. Rev Latinoamer Oncol Clin 1988;20(5):5–19.

6. Jungi W.F., Osterwalder B. [Approach in metastasis with unknown primary tumor (In German)]. Schweiz Med Wochenschr 1990;120(35):1273–9.

7. Fedotenko S.P. Metastases of cancer in the neck lymph nodes without a detected primary focus (clinic, diagnosis, treatment). Abstract of the dis. … cand. of med. sciences. Moscow, 1978. 20 p. (In Russ.).

8. Cheng A.T.L., Dorman B. Fine needle aspiration cytology: the Auckland experience. Aust N Z J Surg 1992;62(5):368–72. DOI: 10.1111/j.1445-2197.1992. tb07205.x.

9. Rapkiewicz A., Le B.T., Simsir A. et al. Spectrum of head and neck lesions diagnosed by fine-needle aspiration cytology in the pediatric population. Cancer 2007;111(4):242–51. DOI: 10.1002/cncr.22769.

10. Murthy P., Laing M.R., Palmer T.J. Fine needle aspiration cytology of head and neck lesions: an early experience. J R Coll Surg Edinb 1997;42(5):341–6.