{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:32:08Z","timestamp":1785799928067,"version":"3.56.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>This systematic review aims to evaluate the role of biopsies in non\u2010oropharyngeal subsites in patients with cervical metastasis from head and neck squamous cell carcinoma of unknown primary (HNSCCUP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) statement. Articles that encompassed non\u2010oropharyngeal biopsies in HNSCCUP as part of the diagnostic work\u2010up were selected and analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A comprehensive search strategy was used to search relevant literature in PubMed from inception to October 2021. Eleven articles out of 860 were included, comprising 990 patients. There are no randomised control trials comparing the outcomes of survival and or locoregional control between patients who have or have not undergone non\u2010targeted biopsies of non\u2010oropharyngeal sub\u2010sites for HNSCCUP.<\/jats:p><jats:p>Several retrospective studies which showed an extremely low yield from random biopsies (range of yield, 0%\u20139%) of non\u2010oropharyngeal subsites. Even targeted biopsies showed a low yield (range of yield, 0.6%\u201316.6%) from non\u2010oropharyngeal subsites. The primary site identified for Epstein\u2013Barr virus (EBV) positive cervical lymph nodes with an unknown primary is mainly the nasopharynx (51.7%). Narrow band imaging (NBI) (sensitivity range, 64%\u201391%) helps in the detection of primaries to target biopsies in non\u2010oropharyngeal subsites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>On the basis of this systematic review, it is not appropriate to offer biopsies of clinically and radiologically normal upper aerodigestive tract mucosa at non\u2010oropharyngeal sites. Offer nasopharyngeal biopsies when the cervical node sampling reveals EBV\u2010positive metastasis. Where available, NBI should be used to help detect and target biopsies in non\u2010oropharyngeal subsites.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.14157","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T04:58:28Z","timestamp":1714107508000},"page":"531-537","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The role of non\u2010oropharyngeal biopsies in head and neck squamous cell carcinoma of unknown primary: A systematic review"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4457-7584","authenticated-orcid":false,"given":"C. 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