Usefulness of Narrow-band Imaging for Detecting the Primary Tumor Site in Patients with Primary Unknown Cervical Lymph Node Metastasis

Abstract

ObjectiveWe sometimes experienced patients with primary unknown cervical lymph node metastasis. In such cases, if computed tomography, magnetic resonance imaging, laryngoscopy and gastrointestinal endoscopy cannot detect a primary site, there is no other effective method to identify a possible primary tumor. We investigated whether narrow-band imaging can detect a possible primary tumor in such.MethodsForty-six patients with primary unknown cervical lymph node metastasis were surveyed about primary tumors, from January 2003 to December 2006. All cervical lymph nodes were histologically proved to be squamous cell carcinoma by fine-needle aspiration cytology. Narrow-band imaging combined with magnifying endoscopy was used to identify the primary site in the head and neck region and cervical esophagus. Histological analysis was performed for all suspicious lesions by a biopsy specimen.ResultsTwenty-six lesions were suspected to be cancerous lesions by narrow-band imaging in the head and neck region. Sixteen lesions in 16 (35%, 16/46) patients were squamous cell carcinoma. Ten lesions were located in the hypopharynx and the remaining six lesions were located in the oropharynx. White light endoscopy could not point out any lesion.ConclusionsNarrow-band imaging endoscopy can detect possible primary cancer in patients with primary unknown cervical lymph node metastasis.

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

“…The usefulness of NBI with magnifying endoscopy for detecting the primary site of NUP also has been reported. Hayashi et al investigated 46 patients of NUP and 26 lesions were suspected to be cancerous lesions (25). Of 26 patients, 16 lesions in 16 patients (35%, 16/46) were identified to be squamous cell carcinoma.…”

Clinical Experiences of NBI Laryngoscope in Diagnosis of Laryngeal Lesions

“…Superficial lesions are identified by changes in the color tone and irregularity of surface mucosa during endoscopic examinations. NBI has proved to be a useful screening tool in both the upper and the lower gastrointestinal tracts and the lower aerodigestive system [4][5][6]. Since endoscopic observation of superficial laryngeal carcinoma is similar to those of superficial esophageal carcinoma, it has become apparent that observation of the epithelial microvessels is useful in the diagnosis of laryngeal carcinoma as well as other laryngeal lesions [7,8].…”

Role of narrow‐band imaging in detection of head and neck unknown primary squamous cell carcinoma

“…Some authors included into the analysis patients who had been previously evaluated by WL endoscopy and cross‐sectional imaging (CT), without performing a PET scan prior to NBI evaluation. In this setting, the NBI detection rate was 13.3%, 34.8%, 47.2%, and 54.5%, respectively (according to each different study) . Interestingly, most tumors were described as small and superficial, underlying the prominent role of NBI in detection of SCCs that had been previously missed by imaging and WL endoscopy due to their limited extension.…”

“…SCCUP is by definition a diagnosis of exclusion, and what constitutes appropriate investigation has still to be clearly defined. Identification of the primary is essential to focus on site‐specific targeted therapy, which minimizes the significant morbidity associated with wide‐field radiation such as salivary gland disorders, severe mucositis, fibrosis, and taste dysfunction . Every effort should therefore be devoted to identifying occult primary tumors in these patients .…”