Study of the Usefulness of p16 Immunostaining and EBER-ISH for Primary Unknown Carcinoma with Cervical Neck Lymph Node Metastasis

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  • Sekimizu Mariko
    Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine
  • Mikoshiba Takuya
    Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine
  • Nagai Ryoto
    Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine
  • Takebayashi Akiko
    Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine
  • Saito Shin
    Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine
  • Nakamura Shintaro
    Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine Department of Otolaryngology, Kitasato University Kitasato Institute Hospital
  • Kameyama Kaori
    Department of Pathology, Showa University Northern Yokohama Hospital
  • Ozawa Hiroyuki
    Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine

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Other Title
  • 原発不明癌頸部リンパ節転移に対する p16 免疫染色および EBER-ISH の有用性についての検討
  • ゲンパツ フメイガン ケイブ リンパセツ テンイ ニ タイスル p16 メンエキ センショク オヨビ EBER-ISH ノ ユウヨウセイ ニ ツイテ ノ ケントウ

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Abstract

<p>　The frequency of cervical lymph node carcinoma metastasis from unknown primary site (CCUP) has not decreased in spite of the improved capabilities of the tools needed for diagnosis. This has been reported as being related to the increasing incidence of HPV-related oropharyngeal cancer. In 2017, the 8th edition of the UICC was revised to require p16 immunostaining and EBER for histological examination of the cervical lymph nodes in CCUP. In this study, we investigated the diagnosis of 27 cases of CCUP that could not be determined by general examination. We performed p16 and TTF-1 immunochemistry, EBER in situ hybridization assay of the lymph nodes and compared the results with the clinical course. Of the 27 cases, the primary was found in 18 cases, including 1 case of nasopharyngeal carcinoma, 12 cases of oropharyngeal carcinoma, 4 cases of hypopharyngeal carcinoma, and 1 case of lung carcinoma. Positivity for EBER was found in the nasopharyngeal carcinoma case, and positive immunostaining for p16 was found in all cases of oropharyngeal carcinoma, confirming its reliability as a biomarker. In addition, the p16 positivity rate was 67% in 9 cases of unknown primary. Other authors have reported that about 80% of CCUP cases are p16-positive, suggesting the need for more careful observation of the lateral and anterior walls of the oropharynx when searching for the primary.</p>

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