Head and neck cancers are a major cause of cancer-related deaths all over the world.2 In 2008, more than 500,000 patients were diagnosed of head and neck cancers, with around 6,000 cases from the United Kingdom, making them the most fifth prevalent carcinomas.3 In addition, CUP of the head and neck often metastasizes to the lymph nodes, representing 3-5% of all head and neck malignant tumors.4 Schmalbach and Miller4 pointed out that it is important to detect the sites of occult primary for allowing site-specific therapy and minimizing the side effects of radiation from treatment. Thus, multiple methods have been utilized for the detection of primary lesions. These methods include physical assessment and endoscopic examination of the head, neck, and upper aero-digestive tract in addition to cross-sectional imaging with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Although the majority of primary tumors are successfully detected by these investigations, 2-9% of the origins of primary tumors remain undiscovered.5


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