Transoral robotic biopsy of the tongue base: A novel paradigm in the evaluation of unknown primary tumors of the head and neck

Head Neck. 2013 Apr;35(4):E126-30. doi: 10.1002/hed.21968. Epub 2011 Dec 16.


Background: Squamous cell carcinoma of the head and neck can present as a cervical metastasis from an unknown primary site. The standard diagnostic workup includes panendoscopy and directed biopsies but this will fail to identify a portion of unknown primary tumors.

Methods: Herein, we present a case report of a male patient with an unknown primary tumor in which the da Vinci surgical robot was used to evaluate the tongue base.

Results: Clinical evaluation, imaging, and panendoscopy with directed biopsies failed to detect the primary tumor site. Robot-assisted biopsy of a broad area of the tongue base, incorporating submucosal tissue, identified the primary tumor with minimal postoperative morbidity.

Conclusion: Failure to localize an unknown primary tumor often results in widespread irradiation of the upper aerodigestive tract, inducing significant morbidity. Robot-assisted biopsies of the tongue base may identify unknown primaries that would otherwise have been missed through standard directed biopsy techniques.

Publication types

  • Case Reports

MeSH terms

  • Biopsy
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / surgery
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / surgery
  • Humans
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasms, Unknown Primary / pathology
  • Neoplasms, Unknown Primary / surgery
  • Robotics / methods*
  • Squamous Cell Carcinoma of Head and Neck
  • Tongue / pathology*
  • Tongue / surgery