Transoral and Cervical Ultrasound of Patients With Suspected Oropharyngeal Cancer

Introduction The current diagnostic approach for patients with suspected oropharyngeal cancer involves a combination of clinical examination, tissue sampling, and relevant cross-sectional imaging. Previous studies have shown that transoral and cervical ultrasound (US) of the palatine and lingual tonsils has a better diagnostic accuracy than clinical investigation and magnetic resonance imaging (MRI) in patients with suspected oropharyngeal cancer, but it has not been established whether adding this scan to the diagnostic workup has a clinical impact. Methods A randomized controlled study, including 170 patients at four different Head and Neck Hospital departments in Denmark. One group receives standard diagnostics (control group), and the other group receives standard diagnostics supplemented by transoral and cervical ultrasound of the lingual and palatine tonsils. The diagnostic accuracy, number of correct biopsies, number of imaging modalities ordered, and time to final diagnosis are noted. Conclusion This randomized controlled study examines whether the implementation of transoral and cervical ultrasound of the palatine and lingual tonsils in patients with suspected oropharyngeal cancer will improve the diagnostic accuracy and have a clinical impact. This concerns more accurate initial diagnoses, more correct biopsies, fewer unnecessary scans, and fewer visits to the outpatient clinic.

Introduction The incidence of oropharyngeal cancer is rising globally. The diagnostic approach for patients with suspected oropharyngeal cancer includes clinical examination and tissue samples in the outpatient clinic (biopsies), followed by relevant cross-sectional imaging (computed tomography (CT), magnetic resonance imaging (MRI), and sometimes 18F-Fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT)). It can be challenging to distinguish small oropharyngeal cancers from benign unilateral tonsil hypertrophy by clinical examination and relevant cross-sectional imaging. Small tumors of the palatine- or lingual tonsils may appear as normal oropharyngeal lymphoid tissue in the clinic and on CT and MRI scans, and normal tonsillar asymmetry can resemble an oropharyngeal cancer. The enhanced metabolic activity of the lingual and palatine tonsils on a PET-CT can blur abnormal activity from a small tumor, and increased one-sided metabolic activity due to inflammation raises suspicion of malignancy. This results in expensive, and, in some cases, painful additional interventions such as biopsies, diagnostic surgeries, and additional cross-sectional imaging. By far the most common sublocation of oropharyngeal cancers is the palatine and lingual tonsils. Advances in ultrasound (US) technology and smaller high-frequency (\>15 MHz) transducers make the palatine and lingual tonsils more accessible for examination. This is done by using a transoral approach, where the transducer can reach the palatine and lingual tonsil directly with access via the oral cavity. Garset-Zamani et al. describe how transoral and cervical US of the palatine and lingual tonsils have a significantly higher diagnostic accuracy than clinical examination and MRI in patients with suspected oropharyngeal cancer. Cervical US for oropharyngeal cancer diagnostics is demonstrated in several studies. Coquia et al. describe how cervical US can be used to visualize tumors in the lingual and palatine tonsils, advocating for its possibility to fill a gap in tumor characterization, adding information gathered by MR and CT. US is a low-cost, easily accessible, radiation-free dynamic imaging modality. No previous randomized trials have investigated whether the addition of cervical and transoral US improves the diagnostic accuracy and has a clinical impact. Possible clinical benefits include more accurate initial diagnoses, improved biopsy accuracy, fewer unnecessary scans, fewer outpatient clinic visits, and fewer diagnostic surgeries. In summary, achieving a more precise diagnosis with fever interventions. Should this research prove successful, it could lead to the implementation of US of the palatine and lingual tonsils in the outpatient cancer clinic and substantial advancements in oropharyngeal cancer management. Research question In patients referred to the outpatient cancer clinic suspected of oropharyngeal cancer, does a clinical examination including transoral and cervical u trial.show_full_description

Inclusion Criteria: Referred to outpatient cancer clinic with one of the following: * A scan (MR, CT, PET/CT) suggesting malignancy in the oropharynx. This being asymmetric metabolic activity on PET/CT, a tumor or asymmetry of the palatine and lingual tonsils on MR and CT (7). * Tumor suspicious findings (erosion/ulcus, tonsil asymmetry/hypertrophy). * Tumor-suspicious symptoms (pain of the oropharynx) * \> 18 years of age. * Ability to understand and give informed consent. Exclusion Criteria: * • Prior oropharyngeal cancer * Prior radiation to the head and neck area