原发性不明的鳞状细胞癌 (SCCUP) 通常呈人乳头瘤病毒 (HPV) 阳性。由于它们体积小，需要进行广泛的手术检查来定位原发肿瘤。高频经口超声（US）可以改善这些小肿瘤的可视化。我们的研究旨在探讨外科医生对 HPV 阳性 SCCUP 患者进行术中经口超声是否可以改善全内窥镜检查期间原发性肿瘤的检出。这是一项单中心、前瞻性诊断研究，包括在全身麻醉下接受全内窥镜检查的 HPV 阳性 SCCUP 患者。所有患者均进行术前 MRI、PET/CT 和淋巴结转移的 HPV DNA 检测。在全内窥镜检查之前进行术中经口超声检查。对超声结果不盲进行冰冻切片活检，如果初始活检呈阴性，则尝试经口超声引导活检。如果冰冻切片呈阴性，则通过腭和/或舌扁桃体切除术获得最终的组织病理学结果。主要结果是术中经口超声和全内窥镜检查的原发肿瘤检出率。纳入 30 名患者：24 名 (80%) 为男性，中位年龄为 60 岁 [范围 35-79 岁]。确认了 29 个原发性肿瘤 (97%)；舌扁桃体和腭扁桃体分别有 18 个 (62%) 和 10 个 (34%)，后口咽部有 1 个 (3%)。经口超声定位原发肿瘤的敏感性显着高于全内窥镜检查（93% vs 76%，p = 0.02），并且显着高于术前 PET/CT（62%，p = 0.002）、CT（45%， p < 0.001) 和 MRI (28%，p < 0.001)。全内窥镜检查期间的术中经口超声是一种有前景的诊断工具，可以提高 HPV 阳性 SCCUP 的检测。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

Squamous cell carcinomas of unknown primary (SCCUP) are often Human Papillomavirus (HPV)-positive. Due to their small size, extensive surgical workup is required to locate the primary tumors. High-frequency transoral ultrasound (US) may provide improved visualization of these small tumors. Our study aimed to explore whether surgeon-performed intraoperative transoral US for patients with HPV-positiveSCCUP could improve primary tumor detection during panendoscopy.This was a single-center, prospective diagnostic study including patients undergoing panendoscopy under general anesthesia with HPV-positive SCCUP. Preoperative MRIs, PET/CTs, and HPV DNA-testing of lymph node metastases were performed in all patients. Intraoperative transoral US was performed prior to panendoscopy. Frozen section biopsies were performed unblinded to US results, and transoral US-guided biopsies were attempted if initial biopsies were negative. Final histopathology was obtained with palatine- and/or lingual tonsillectomy if frozen section was negative. The main outcome was the primary tumor detection rate with intraoperative transoral US and panendoscopy.Thirty patients were included: 24 (80 %) were men, and the median age was 60 years [range 35-79 years]. Twenty-nine primary tumors (97 %) were confirmed; 18 (62 %) and 10 (34 %) in the lingual- and palatine tonsils, respectively, and one (3 %) in the posterior oropharynx. Transoral US had a significantly higher sensitivity than panendoscopy to locate the primary tumor (93 % vs 76 %, p = 0.02), and significantly higher than pre-operative PET/CT (62 %, p = 0.002), CT (45 %, p < 0.001), and MRI (28 %, p < 0.001).Intraoperative transoral US during panendoscopy is a promising diagnostic tool that may improve the detection of HPV-positive SCCUP.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.