Management of the unknown primary in patients with metastatic cancer of the head and neck

Abstract

The evaluation of the patient with metastatic cervical lymph node squamous cell carcinoma and an unknown primary tumor frequently involves the use of guided biopsies as a diagnostic tool. This study was performed to assess the effectiveness of these biopsies. Using a retrospective chart review, we identified 25 patients who had undergone a total of 100 guided biopsies to evaluate an unknown primary malignancy of the head and neck. We found that 99 of the 100 biopsies were negative for malignancy. Although guided biopsies were obviously not helpful in these cases, we believe this might be attributable to the fact that the method of performing them is inconsistent among surgeons. Therefore, we present an algorithm for the management of the unknown primary head and neck malignancy, including recommendations regarding the use of guided biopsies.