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The purpose of this systematic review and meta-analysis was to identify the prevalence of synchronous contralateral tonsil carcinoma (SCTC) amongst patients with tonsil carcinoma or head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Thirteen retrospective studies, comprising 2623 patients, were analysed, revealing an overall pooled SCTC prevalence of 4%, rising to 10% in HNSCCUP cases. HPV/p16 positivity was associated with SCTC prevalence of 3%, while HPV/p16 negativity was greater at 8%. Clinical or imaging evaluations often missed SCTC preoperatively, emphasising the importance of contralateral tonsillectomy. Morbidity varied among patients undergoing contralateral tonsillectomy. The prevalence of SCTC is significant in cases of HNSCCUP and tonsil malignancy, emphasising the importance of informed discussions regarding contralateral tonsillectomy. Tailored approaches considering individual patient and tumour characteristics are crucial, with contralateral tonsillectomy generally warranted in HNSCCUP. Further research, including prospective studies with standardised protocols, is needed to improve the understanding and management of SCTC, specifically the clinical significance of occult SCTC.
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http://dx.doi.org/10.1016/j.oraloncology.2025.107180 | DOI Listing |
JAMA Otolaryngol Head Neck Surg
August 2025
Head and Neck Tumor Center at Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri.
Importance: Transoral surgery via a radical tonsillectomy followed by pathology-guided adjuvant therapy is standard of care for tonsillar squamous cell carcinoma (SCCa). There is significant variation in the management of the contralateral tonsil without clinical evidence of disease.
Objective: To assess the second primary tumor rates, oncologic survival, functional outcomes, and complications between bilateral and unilateral transoral surgery for tonsillar SCCa.
Head Neck
July 2025
Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Background: Diagnostic test properties for PET-CT in the setting of carcinoma of unknown primary (CUP) of the head and neck have been previously reported in the setting of limited pathologic correlation resulting in biased reporting. With the advent of transoral robotic techniques such as lingual tonsillectomy, the ability to identify small volume primaries has improved. This study aims to investigate the diagnostic test properties of PET-CT for carcinomas of unknown primary (CUP) of the head and neck.
View Article and Find Full Text PDFJAMA Otolaryngol Head Neck Surg
July 2025
Head and Neck Tumor Center at Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri.
Importance: The palatine tonsil is the most common subsite of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC). There is debate on how to manage the contralateral clinically uninvolved tonsil in patients undergoing a primary surgical approach via transoral robotic surgery (TORS).
Objective: To assess postoperative complications, functional outcomes, contralateral tonsil second primary rates, and survival in patients undergoing unilateral vs bilateral TORS with pathology-guided adjuvant treatment.
The purpose of this systematic review and meta-analysis was to identify the prevalence of synchronous contralateral tonsil carcinoma (SCTC) amongst patients with tonsil carcinoma or head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Thirteen retrospective studies, comprising 2623 patients, were analysed, revealing an overall pooled SCTC prevalence of 4%, rising to 10% in HNSCCUP cases. HPV/p16 positivity was associated with SCTC prevalence of 3%, while HPV/p16 negativity was greater at 8%.
View Article and Find Full Text PDFClin Otolaryngol
May 2025
Head and Neck Unit, The Royal Marsden Hospital, London, UK.
Objectives: Head and neck squamous cell carcinoma from unknown primary (HNSCCUP) is a rare and challenging condition. This study aimed to investigate the diagnostic pathways of suspected HNSCCUP patients in the United Kingdom.
Methods: A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT (PET-CT) within 3 months of diagnosis with metastatic cervical squamous cell carcinoma.