Abstract：
BACKGROUND: Patients presenting with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remain challenging clinical scenarios as large variation exists in practices used to locate the primary.
OBJECTIVE: The objective of this systematic review is to review of the literature and offer recommendations for oropharyngeal biopsies in HNSCCUP.
METHODS: Pubmed, Medline and Embase were searched to identify studies from inception to October 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.
RESULTS: A total of 483 articles were included and screened, 41 studies met the inclusion criteria, including over 3400 patients from the original articles (122 of these patients were reported on in two sequential articles by a single author - table 1) and 4 large metaanalyses including 1852 patients. The primary site identification rate following random biopsies or deep tissue biopsies is less than 5% in most studies. The mean detection rate following ipsilateral tonsillectomy is 34%; two pooled analyses indicate that the mean detection rate following tongue base mucosectomy is 64%, with this figure rising when the tonsils are negative.
CONCLUSIONS: High level evidence is lacking, with heterogeneity in the reported studies. Published meta-analyses are based on retrospective data. There is little evidence supporting the practice of random/non-directed oropharyngeal biopsies. Available evidence supports palatine tonsillectomy and tongue base mucosectomy compared to deep tissue biopsies.
OBJECTIVE: The objective of this systematic review is to review of the literature and offer recommendations for oropharyngeal biopsies in HNSCCUP.
METHODS: Pubmed, Medline and Embase were searched to identify studies from inception to October 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.
RESULTS: A total of 483 articles were included and screened, 41 studies met the inclusion criteria, including over 3400 patients from the original articles (122 of these patients were reported on in two sequential articles by a single author - table 1) and 4 large metaanalyses including 1852 patients. The primary site identification rate following random biopsies or deep tissue biopsies is less than 5% in most studies. The mean detection rate following ipsilateral tonsillectomy is 34%; two pooled analyses indicate that the mean detection rate following tongue base mucosectomy is 64%, with this figure rising when the tonsils are negative.
CONCLUSIONS: High level evidence is lacking, with heterogeneity in the reported studies. Published meta-analyses are based on retrospective data. There is little evidence supporting the practice of random/non-directed oropharyngeal biopsies. Available evidence supports palatine tonsillectomy and tongue base mucosectomy compared to deep tissue biopsies.
摘要：
背景：患有未知原发性头颈部鳞状细胞癌（HNSCCUP）的患者仍然具有挑战性，因为用于定位原发性的实践存在很大差异。
目的：本系统综述的目的是回顾文献并为HNSCCUP口咽活检提供建议。
方法：发布，搜索了Medline和Embase，以确定从开始到2021年10月的研究。遵循系统审查和荟萃分析（PRISMA）指南的首选报告项目。
结果：共纳入并筛选了483篇文章，41项研究符合纳入标准，包括来自原始文章的3400名患者(其中122名患者由一位作者在两篇连续文章中报告-表1)和4项大型荟萃分析,包括1852名患者.在大多数研究中，随机活检或深层组织活检后的主要部位识别率小于5％。同侧扁桃体切除术后的平均检出率为34％；两个汇总分析表明，舌根粘膜切除术后的平均检出率为64％，当扁桃体为阴性时，这个数字会上升。
结论：缺乏高水平的证据，在报告的研究中具有异质性。已发表的荟萃分析基于回顾性数据。几乎没有证据支持随机/非定向口咽活检的实践。与深层组织活检相比，现有证据支持腭扁桃体切除术和舌根粘膜切除术。
目的：本系统综述的目的是回顾文献并为HNSCCUP口咽活检提供建议。
方法：发布，搜索了Medline和Embase，以确定从开始到2021年10月的研究。遵循系统审查和荟萃分析（PRISMA）指南的首选报告项目。
结果：共纳入并筛选了483篇文章，41项研究符合纳入标准，包括来自原始文章的3400名患者(其中122名患者由一位作者在两篇连续文章中报告-表1)和4项大型荟萃分析,包括1852名患者.在大多数研究中，随机活检或深层组织活检后的主要部位识别率小于5％。同侧扁桃体切除术后的平均检出率为34％；两个汇总分析表明，舌根粘膜切除术后的平均检出率为64％，当扁桃体为阴性时，这个数字会上升。
结论：缺乏高水平的证据，在报告的研究中具有异质性。已发表的荟萃分析基于回顾性数据。几乎没有证据支持随机/非定向口咽活检的实践。与深层组织活检相比，现有证据支持腭扁桃体切除术和舌根粘膜切除术。
