Tonsillectomy and tonsil biopsy in the search for primary oropharyngeal tumor in patients with CUP

The purpose of the study. To study the role of tonsillectomy and palatine tonsil biopsy in the identification of primary oropharyngeal tumor in patients with CUP. Material and methods. The study included the diagnostic findings of 69 patients with squamous cell cancer (SCC) metastases to the neck lymph nodes from an unknown primary site. Inclusion criteria for the study: the presence of morphologically verified SCC metastases in the cervical lymph nodes based on the FNA (fine needle aspiration biopsy) cytology findings, the pathology findings (cervical lymph node biopsy, core biopsy), no evidence of cervical lymph node metastases from another primary site, and no primary tumor detected upon the initial clinical examination. Thirteen (19%) patients out of 69 with no evidence of a primary tumor after clinical examination and instrumental investigations underwent transoral microsurgical palatine tonsillectomy using a Carl Zeiss operating microscope with cervical lymph node dissection. Biopsy of the tonsil was performed in 7 (10%) out of 69 patients. Results. According to the results of the study, the primary tumor localized in the palatine tonsil was detected in 11 cases (78%) of microsurgical palatine tonsillectomy, and in 2 cases (28%) of the palatine tonsil biopsy. Moreover, according to the IHC results, the verified tonsil cancer was associated with HPV in 62% of cases. Conclusion. Tonsillectomy is a valuable diagnostic option in the search for a primary oropharyngeal tumor in patients with CUP. It allows for targeted treatment (surgical treatment using minimally invasive microsurgical techniques, conformal radiation therapy), reducing the likelihood of developing adverse reactions that alter the patient’s quality of life. Key words: cervical lymph node metastases from unknown primary, palatine tonsillectomy, biopsy of the palatine tonsil, P-16 expression, HPV infection Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study