The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers

Carole Fakhry, Nishant Agrawal, Joseph Califano, Barbara Messing, Jia Liu, John Saunders, Patrick Ha, Stephanie Coquia, Ulrike Hamper, Maura Gillison, Ray Blanco

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background Although human papillomavirus detection in cervical lymph nodes of head and neck squamous cell cancers (HNSCC) of unknown primary site (UP) is indicative of a primary tumor of the oropharynx (OP), localization can remain elusive. Therefore, we investigated ultrasonography (US) for the identification of the primary tumor. Methods Eligible cases had HNSCC of UP after evaluation by a head and neck surgical oncologist. Controls were healthy volunteers. Transcervical and intraoral ultrasonography was performed by a standard protocol using convex (3.75-6.0 MHz and 5-7.5 MHz) transducers. US findings were compared with operative examination (exam under anesthesia, direct laryngoscopy) and biopsies. The primary outcome of interest was the presence or absence of a lesion on US. Results 10 cases and 20 controls were enrolled. PET/CT scans were negative/nonspecific (9), or suspicious (1) for a primary lesion. On US, predominantly hypoechoic (9 of 10) lesions were visualized consistent with base of tongue (n = 7) or tonsil (n = 3) primary tumors. On operative examination, 5 of 10 were appreciated. Two additional primaries were confirmed with biopsies "directed" by preoperative US. This represents an overall diagnostic rate of 70%, which is 20% higher than our detection rate for 2008-2010. The three cases in which a suspicious lesion was visualized on US, yet remained UP despite further interventions, could represent false positives, misclassification or operator variability. No lesions were suspected among the controls. Conclusion Ultrasound has promise for detection of UPs of the OP and therefore warrants further investigation.

Original languageEnglish (US)
Pages (from-to)640-645
Number of pages6
JournalOral Oncology
Issue number7
StatePublished - Jul 2014


  • Head and neck cancer
  • Human papillomavirus (HPV)
  • Oropharynx neoplasm
  • Ultrasonography
  • Unknown primary

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research


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