Evidence map›Paper›PMID 42059064›Full record

ArticleOtolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery2026

A Standardized Algorithm's Impact on Primary Detection in Head and Neck Carcinoma of Unknown Primary.

Thomas G Townes, Julian Martinez, Neil D Gross, Guojun Li, Ryan Goepfert, Jeffrey Myers, Andrew G Sikora, Karen Choi, Katherine A Hutcheson, Wenye Song and 13 more

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Article in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Thomas G TownesDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID https://orcid.org/0009-0000-3407-4719
Julian MartinezDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Neil D GrossDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Guojun LiDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Ryan GoepfertDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jeffrey MyersDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Andrew G SikoraDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Karen ChoiDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Katherine A HutchesonDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Wenye SongDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Anna LeeDepartment of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Amit MoranDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Carol M LewisDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Neal AkhaveDepartment of Thoracic-Head & Neck Med Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Faye JohnsonDepartment of Thoracic-Head & Neck Med Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Luana G De SousaDepartment of Thoracic-Head & Neck Med Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Anastasios ManiakasDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jennifer R WangDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Shirley Y SuDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Stephen Y LaiDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Ehab HannaDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Xiao ZhaoDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Miriam N LangoDepartment of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID https://orcid.org/0000-0003-0736-7473

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

OBJECTIVE(S): National guidelines for HPV-associated head and neck squamous cell carcinoma of unknown primary (HNSCCUP) were adapted into a standardized institutional diagnostic algorithm. This study evaluated the impact of algorithm implementation on primary site detection, treatment selection, and oncologic outcomes. STUDY

designRetrospective implementation study.

settingSingle tertiary-care cancer center.

methodsWe reviewed patients with clinically occult, PET/CT nonlocalizing HPV-associated HNSCCUP treated before (2014-2021) and after (2022-2023) implementation of the algorithm.

resultsAmong 139 patients, those treated after algorithm implementation (n = 33) were more likely to undergo robotic ipsilateral lingual ± palatine tonsillectomy rather than bilateral palatine tonsillectomy, resulting in higher mucosal detection rates (88% vs 59%, P = .003). Postimplementation patients were more likely to receive primary surgical rather than nonsurgical treatment (54% vs 20%, P < .001) and unilateral radiotherapy without elective contralateral nodal irradiation (78% vs 43.5%, P = .002). Algorithm implementation was associated with a fourfold increase in the odds of primary site detection (OR 4.1, 95% CI 1.3-13.0, P = .018); however, detection rates also increased in HNSCCUPs not managed with robotic surgery, from 57% to 87% (P = .04). After implementation, 21.2% of patients received surgery alone compared with 5.7% prior, while postoperative chemoradiation was used in 9.1% versus 3.8%, respectively. No locoregional failures have occurred since implementation.

conclusionImplementation of a standardized diagnostic algorithm for HPV-associated HNSCCUP significantly improved primary site detection and altered treatment without compromising disease control. Improvements in detection were not fully explained by the use of robotic surgery. Potential functional benefits warrant further study. LEVEL OF EVIDENCE: 4:

Indexed as

AlgorithmsHead and Neck NeoplasmsNeoplasms, Unknown PrimaryPapillomavirus InfectionsSquamous Cell Carcinoma of Head and NeckAgedFemaleHumansMaleMiddle AgedPositron Emission Tomography Computed TomographyRetrospective StudiesRobotic Surgical ProceduresTonsillectomydetectionhead and neck squamous cell carcinoma of unknown primaryHPVtransoral robotic surgery

Identifiers

PMID42059064
PMCPMC13417944

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.