Video-assisted lingual tonsillectomy in the identification of primary tumors in patients with CUP syndrome

Objective. To analyze the role of video-assisted lingual tonsillectomy in the identification of latent oropharyngeal carcinoma in patients with CUP syndrome. Material and methods. The study is based on the results of diagnostic data from 68 patients with metastases of squamous cell carcinoma of unclear primary localization. The key criteria for inclusion in the study were the presence of metastases of squamous cell carcinoma in the lymph nodes of the neck, confirmed by morphological examination, the lack of data for the primary focus after the standard volume of clinical diagnostic studies, as well as the lack of data for metastatic lesion of lymph nodes of other localization. Taking into account the presence of increased expression of the p16 protein in metastatically altered lymph nodes of the neck and the lack of information about the primary tumor site after instrumental diagnosis and clinical examination, video-assisted lingual tonsillectomy in combination with cervical lymph node dissection was performed in 11 patients, which accounted for 16% of the total number. Results. Using the method of video-assisted lingual tonsillectomy, the primary tumor lesion localized in the root of the tongue was identified in 6 (55%) of 11 patients. The primary tumor in all operated patients was squamous cell carcinoma of varying degrees of differentiation. Conclusion. Analysis of p16 protein expression levels and performance of lingual tonsillectomy provide important diagnostic options in the detection of asymptomatic malignant tumors of the oropharynx. Identification of the primary tumor in patients with metastatic cervical lymph nodes of unknown primary localization is important in determining the extent of adjuvant therapy.