Role of Chest Computed Tomography in Head and Neck Cancer

Abstract

To evaluate the role of chest computed tomography (CT) in patients with head and neck squamous cell carcinoma (HNSCC) and to determine the optimal timing and predictive factors for positive findings. Design: Retrospective analysis. Setting: Tertiary referral center. Patients: Two hundred seventy screening chest CT scans performed in 192 patients with HNSCC during a 42month period were reviewed. Main Outcome Measures: The scans were categorized as new cases, follow-up cases, or recurrent cases. The results were classified as abnormal or normal. Scans of patients having a radiologic diagnosis of a malignant neoplasm of the lung or an indeterminate lesion were considered abnormal. Factors correlating with an abnormal chest CT scan or development of malignant neoplasm of the lung were analyzed, including the timing of imaging and the patients' clinicopathologic data. Results: Seventy-nine scans (29.3%) were considered abnormal. The rate of an abnormal scan was significantly higher in the follow-up case group (44.2%) than in the new case group (14.2%) (P Ͻ.001). Ten of 15 indeterminate scans (66.7%) with small (Ͻ1 cm) solitary pulmonary nodules showed disease progression on subsequent follow-up scans, changing the patients' diagnoses to a malignant neoplasm of the lung. The predictive factors for development of a malignant neoplasm of the lung were initial N2 or N3 disease, stage IV disease, recurrent disease, and distant metastasis to another site. Conclusions: Chest CT is recommended for high-risk patients, especially during the follow-up period. Intensified evaluation and management are mandatory for indeterminate small solitary pulmonary nodules because of the high rate of malignant neoplasms.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer

“…The most common site of distant metastasis are the lungs and various centers around the world consider screening for lung metastasis important in these patients 7 . However, the widespread use of CT is still controversial, since, theoretically, it would have a greater impact on therapy by detecting alterations in initial cases, although some authors demonstrate limitations of its routine use in all cases, especially in the newly diagnosed 10 . Thus, there was search for parameters associated with a positive chest CT scan, such as the occurrence of regional metastases in stages N2 / N3 and the primary tumor having origin in the oropharynx, hypopharynx or supraglottic region 11 .…”

Post-therapeutic Surveillance Schedule for Oral Cancer: Is There Agreement?

“…Some authors advocate routine CT imaging or plain chest X-ray [7,9,[22][23][24]. Other authors, however, advocate the use of chest X-ray only in symptomatic patients [1,3].…”

“…The predictive factors for development of a malignant neoplasm of the lung were initial N2 or N3 disease, stage IV disease, recurrent disease, and distant metastasis to another site. The authors recommended chest CT for high-risk patients, especially during the follow-up period [24]. Likewise, Manikantan et al [23] reviewed the literature and also recommended chest CT, instead of chest X-rays, for the detection of lung metastasis in patients who could be actively treated.…”

Pretreatment screening on distant metastases and head and neck cancer patients: Validation of risk factors and influence on survival

“…Controversially patients with local recurrence had less distant metastasis in follow up compared to patients with no recurrence. extranodal spread, poor differentiation grade of the primary tumor and tumor depth of invasion and locoregional recurrence, age and race [17][18][19][20][21][22][23] Unfortunately, in the pretreatment selection of patients who may benefit most from screening on distant metastases, risk factors obtained from the histopathological examination of the surgical specimen cannot be used. Moreover, some risk factors may not be independent risk factors.…”