The Effectiveness of Tonsillectomy in the Diagnostic Workup of Squamous Cell Carcinoma Unknown Primary in the Head and Neck Based on p16 Immunohistochemistry

Sep 21, 2026

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Background and objectives: Although p16-positive and p16-negative squamous cell carcinoma unknown primary in the head and neck (HNSCCUP) are distinct entities, the diagnostic workup has not been shown to differ. This study evaluated the effectiveness of palatine tonsillectomy for identifying primary tumors in p16-positive versus p16-negative groups. Materials and methods: Retrospective analysis of HNSCCUP patients managed in two tertiary centers from 2014–2020. Results: Sixty-six patients were included; palatine tonsillectomy revealed tonsillar cancers in 15.4% overall, exclusively in p16-positive cases, with a 27% identification rate among p16-positive patients. Conclusions: Diagnostic workup should be guided by HPV/p16 status; palatine tonsillectomy helps in p16-positive SCCUP, while benefit in p16-negative patients remains uncertain.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Definition and initial evaluation of SCCUP

Role of directed biopsies and endoscopic evaluation

Tonsillectomy strategies (palatine vs lingual) and evolving techniques

Article The Effectiveness of Tonsillectomy in the Diagnostic Workup of Squamous Cell Carcinoma Unknown Primary in the Head and Neck Based on p16 Immunohistochemistry Patrik Stefanicka 1,2, *, Katarina Krupkova 1,3 and Gabriela Pavlovcinová 1,2 Citation: Stefanicka, P.; Krupkova, K.; Pavlovcinová, G. The Effectiveness of Tonsillectomy in the Diagnostic Workup of Squamous Cell Carcinoma Unknown Primary in the Head and Neck Based on p16 Immunohistochemistry. Medicina 2024, 60, 1932. [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.3390/medicina60121932](10.3390/medicina60121932) Academic Editor: Konstantinos Dimas Received: 21 October 2024 Revised: 3 November 2024 Accepted: 21 November 2024 Published: 24 November 2024 Copyright: © 2024 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) . 1 Department of Otorhinolaryngology-Head and Neck Surgery, Medical Faculty, Comenius University Bratislava, 851 07 Bratislava, Slovakia 2 Department of Otorhinolaryngology-Head and Neck Surgery, Bory Hospital, 841 03 Bratislava, Slovakia 3 Department of Otorhinolaryngology, University Hospital Nitra, 950 01 Nitra, Slovakia * [Correspondence: patrikstefanicka@yahoo.com](Correspondence: patrikstefanicka@yahoo.com); Tel.: +421-904635555 Abstract: Background and Objectives: Despite the distinct entity of both p16-positive and p16-negativesquamous cell carcinoma unknown primary in the head and neck (HNSCCUP), the diagnostic workup did not differ. The aim of the study was to determine the effectiveness of palatine tonsillectomy in the identification of primary tumours in two groups of p16-positive and p16-negative HNSCCUP. Materials and Methods: Patients with HNSCCUP managed in two tertiary care referral centres from 1 January 2014 to 31 December 2020 were analysed retrospectively. Results: Sixty-six patients with HNSCCUP diagnosis were included consecutively. HPV status of metastatic cervical lymph nodes using immunohistochemistry with p16 protein was available for all patients. The proportion of both p16-positive and p16-negative groups was not significantly different (p = 0.242) . Of the 39 patients who underwent palatine tonsillectomy, tonsillar cancers were revealed histologically in 6 (15.4%) patients, and all these patients were p16-positive. No primary tonsillar tumour was found in the p16-negative group (0 of 17) . The primary tumour identification rate in p16-positive HNSCCUP patients using palatine tonsillectomy was 27%(6 of 22) . Conclusions: The diagnostic workup of HNSCCUP should be guided according to HPV/p16 status. Palatine tonsillectomy is a useful procedure in identifying primary cancer in p16-positive SCCUP patients, however, its effectiveness in p16-negative patients is debatable. Keywords: carcinoma; squamous cell; Human Papillomavirus Viruses; oropharyngeal neoplasms; carcinoma unknown primary 1. Introduction A patient with proven squamous cell carcinoma in the cervical nodes without an identified primary cancer represents an unknown primary cancer. The majority of patients with neck metastasis have an identified primary tumour after meticulous physical examination, including palpation of the base of the tongue and inspection of the skin, flexible endoscopy (with optical enhancement technologies), and after imaging. Accordingly, patients without primary tumour detection should have undergone endoscopic evaluation under general anaesthesia with at least direct biopsies of tongue base and palatine tonsillectomy being conducted, and only with such evaluation can patients be categorized as having squamous cell carcinoma unknown primary (SCCUP) [1,2]

FAQs

What was the main purpose of the study?

To determine how effective palatine tonsillectomy is in identifying primary tumors in p16-positive compared with p16-negative HNSCCUP patients.

How were patients assessed in the research design?

Patients with HNSCCUP treated at two tertiary referral centers between 2014 and 2020 were analyzed retrospectively, with HPV/p16 status assessed using immunohistochemistry on metastatic cervical lymph nodes.

What were the key findings regarding p16 status and tonsillectomy results?

Among patients who underwent palatine tonsillectomy, histologically confirmed tonsillar cancers occurred only in the p16-positive group, with a 27% primary identification rate in p16-positive SCCUP.

Sep 21, 2026

Uploaded by Theodora