Analysis on Diagnostic Approach, Management and Prognosis of Cervical Metastatic Carcinoma of Unknown Origin

Ahn, Youngjin; Han, Doo Hee; Hah, J Hun; Kwon, Tack Kyun; Sung, Myung Whun; Kim, Kwang Hyun

Abstract

BACKGROUND AND OBJECTIVES: Cervical metastasis of unknown origin (MUO) comprises 3-5% of all head and neck malignancy. Standardized diagnostic approach is not established and standard treatment regimen is not established either. The purpose of this study was to evaluate diagnostic approaches to detect the primary site in patients with neck mass of metastatic squamous cell carcinoma and analyze treatment modalities and their outcomes as well.
SUBJECTS AND METHOD
Of 710 patients who had been diagnosed with squamous cell carcinoma of the head and neck site from Jan. 1992 through Dec. 2005, 73 patients were referred to or visited our clinic regarding the presence of neck mass. With retrospective review of the medical record, the diagnostic approaches were evaluated. Thirty patients, in whom the primary sites were not found after all, were included for analysis of treatments and outcomes.
RESULTS
The diagnostic steps that revealed the primary sites were as follows: physical examination in 29 cases (39.7%), conventional imaging (CT or MRI) in 5 cases (6.8%), PET scan in 1 case (1.4%), OPD based directed biopsy in 3 cases (4.1%), and intraoperative directed biopsy in 5 cases (6.8%). Primary sites were not detected in 30 cases (41.1%). Complete remission was obtained in 24 patients, for whom 5-year disease free survival rate was 62.1%.
CONCLUSION
Thorough physical examination and directed biopsy are strongly recommended for the diagnosis of MUO, but the diagnostic value of PET scan needs to be followed up with more cases.