Investigations for Suspected Head and Neck Squamous Cell Carcinoma of Unknown Primary (HNSCCUP): A National Cohort Study

• DOI: 10.1111/coa.14272
• Publication Date: 2025-01-09T02:39:34Z
• Authors: John C. Hardman; James Constable; Andrew Williamson; Sian Dobbs; Christopher Hogan; Kate Hulse; Shivun Khosla; Kristijonas Milinis; Ben Tudor‐Green; Vinidh Paleri

ABSTRACT Objectives Head and neck squamous cell carcinoma from unknown primary (HNSCCUP) is a rare challenging condition. This study aimed to investigate the diagnostic pathways of suspected HNSCCUP patients in United Kingdom. Methods A retrospective observational cohort was conducted, over 5 years January 2015, UK Neck centres consecutive adults undergoing 18F‐Fluorodeoxyglucose‐PET‐CT (PET‐CT) within 3 months diagnosis with metastatic cervical carcinoma. Patients no site on examination previous head cancer were eligible. Results Data for 965 received 57 centres; 68.5% HPV‐related disease. Three investigation cycles observed: ultrasound biopsy, cross‐sectional imaging (MRI and/or CT) PET‐CT, at median times 17, 29.5 46 days referral. No identified PET‐CT 49.8% ( n = 478/960). Diagnostic tonsillectomy performed 58.2% 278/478) tongue base mucosectomy (TBM) 21.7% 104/479). Ipsilateral carried highest yield (18.7%, 52/278), followed by TBM (15.4%, 16/104). Contralateral tonsillectomy, 49.0% 234/478), lowest (0.9%, 2/234). concurrent MRI associated higher detection than CT p 0.003). minority treatment curative intent first‐definitive‐treatment 62 referral (15.2%, 77/505, 92 days, IQR: 71–117). Conclusions Most experienced protracted pathway waited definitive treatment. Earlier may expedite diagnosis. appears more productive contralateral detection.