{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:46:40Z","timestamp":1781239600652,"version":"3.54.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Head and neck squamous cell carcinoma from unknown primary (HNSCCUP) is a rare and challenging condition. This study aimed to investigate the diagnostic pathways of suspected HNSCCUP patients in the United Kingdom.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective observational cohort study was conducted, over 5\u2009years from January 2015, in UK Head and Neck centres of consecutive adults undergoing 18F\u2010Fluorodeoxyglucose\u2010PET\u2010CT (PET\u2010CT) within 3\u2009months of diagnosis with metastatic cervical squamous cell carcinoma. Patients with no primary site on examination and no previous head and neck cancer were eligible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data for 965 patients were received from 57 centres; 68.5% were HPV\u2010related disease. Three investigation cycles were observed: ultrasound with biopsy, cross\u2010sectional imaging (MRI and\/or CT) and PET\u2010CT, at median times of 17, 29.5 and 46\u2009days from referral. No primary was identified on PET\u2010CT in 49.8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009478\/960). Diagnostic tonsillectomy was performed in 58.2% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009278\/478) and tongue base mucosectomy (TBM) in 21.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009104\/479). Ipsilateral tonsillectomy carried the highest diagnostic yield (18.7%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200952\/278), followed by TBM (15.4%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916\/104). Contralateral tonsillectomy, performed in 49.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009234\/478), carried the lowest yield (0.9%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092\/234). PET\u2010CT with concurrent MRI was associated with higher primary site detection than PET\u2010CT with concurrent CT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). A minority of patients undergoing treatment with curative intent received first\u2010definitive\u2010treatment within 62\u2009days of referral (15.2%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200977\/505, median 92\u2009days, IQR: 71\u2013117).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most patients experienced a protracted diagnostic pathway and waited over 3 months for definitive treatment. Earlier PET\u2010CT with concurrent MRI may expedite diagnosis. TBM appears more productive than contralateral tonsillectomy for primary site detection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/coa.14272","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T21:39:34Z","timestamp":1736372374000},"page":"462-473","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Investigations for Suspected Head and Neck Squamous Cell Carcinoma of Unknown Primary (\n                    <scp>HNSCCUP<\/scp>\n                    ): A National Cohort Study"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6591-5119","authenticated-orcid":false,"given":"John C.","family":"Hardman","sequence":"first","affiliation":[{"name":"Head and Neck Unit, The Royal Marsden Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0354-0179","authenticated-orcid":false,"given":"James","family":"Constable","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery Gloucestershire Royal Hospital  Gloucester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3861-4847","authenticated-orcid":false,"given":"Andrew","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery Monklands University Hospital  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9255-1795","authenticated-orcid":false,"given":"Sian","family":"Dobbs","sequence":"additional","affiliation":[{"name":"Manchester Royal Infirmary, Manchester Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7476-1927","authenticated-orcid":false,"given":"Christopher","family":"Hogan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery Basildon University Hospital  Basildon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2445-0279","authenticated-orcid":false,"given":"Kate","family":"Hulse","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery Queen Elizabeth University Hospital  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2436-8363","authenticated-orcid":false,"given":"Shivun","family":"Khosla","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery Royal Surrey County Hospital  Guildford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1311-0335","authenticated-orcid":false,"given":"Kristijonas","family":"Milinis","sequence":"additional","affiliation":[{"name":"Liverpool Head and Neck Centre, Liverpool University Foundation Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3073-7970","authenticated-orcid":false,"given":"Ben","family":"Tudor\u2010Green","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery Derriford Hospital  Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7933-4585","authenticated-orcid":false,"given":"Vinidh","family":"Paleri","sequence":"additional","affiliation":[{"name":"Head and Neck Unit, The Royal Marsden Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"INTEGRATE (The UK ENT Trainee Research Network)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21899"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.593164"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2018.11.020"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/S002221512400032X"},{"key":"e_1_2_11_6_1","unstructured":"NHS England and NHS Improvement \u201cNHS Diagnostic Waiting Times and Activity Data [Internet] \u201d(2020). 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