Diagnostic Value of Lingual Tonsillectomy in Unknown Primary Head and Neck Carcinoma Identification After a Negative Clinical Workup and Positron Emission Tomography-Computed Tomography

Objective: Diagnostic rates of unknown primary head and neck carcinoma (UPHNC) using lingual tonsillectomy (LT) are highly variable. This study sought to determine the diagnostic value of lingual tonsillectomy in UPHNC identification using strict inclusion criteria and definitions to produce a more accurate estimate of diagnosis rate. Methods: In this retrospective chart review, records of patients who underwent LT for UPHNC were reviewed. Inclusion criteria included absence of suspicious findings on physical exam and PET-CT as well as negative biopsies after pan-endoscopy and palatine tonsillectomy. Following inclusion criteria, sixteen patients were reviewed. A systematic literature review on lingual tonsillectomy for the workup of CUP was also performed. Results: LT was performed using transoral robotic surgery (TORS), transoral laser microsurgery (TLM), or trans-oral microsurgery with cautery (TMC). Following LT, primary tumor was identified in four patients out of sixteen. Detection rate by technique was 1/6, 2/7, and 1/3 for TORS, TLM, and TMC respectively. Post-operative bleeding occurred in three patients (19%), however this was not related to the lingual tonsillectomy. Following literature review, twelve studies were identified, however only three had enough data to compare against. All three studies had a cohort with suspicious findings on clinical exam. A total of 34 patients had a negative workup, with no suspicious findings on clinical exam and subsequently received a LT. Conclusions: This study suggests that LT should be considered initially in the diagnostic algorithm for UPHNC. This study can increase the patient size in this cohort by approximately 47%.