Role of computerized tomography (CT) scan of the chest in patients with newly diagnosed head and neck cancers

Abstract

Chest metastases and second primaries are not uncommon in patients with head and neck cancer. Early detection of a second site of malignant disease may alter prognosis and management. This study assessed the diagnostic yield of chest radiographs compared with computerized tomography (CT) in a series of patients with head and neck cancer. Forty-four consecutive patients with a head and neck squamous cell carcinoma (SCC) attending the head and neck surgery department of Cumberland Infirmary, Carlisle, between January 2000 and December 2000 were included in this prospective study. Patients with lymphomas and localized cancers of the skin and lip were excluded. Thirty men and 14 women, with a mean age of 67 years, were assessed. All had chest radiographs and chest CT at the same time as the CT scan of the primary site. Only one patient had a true positive finding on chest radiograph. Five patients had an abnormal chest CT. Of these, two had multiple lung metastases, and another patient had biopsy-proved bronchogenic carcinoma and underwent surgical excision. The sensitivity and specificity of CT scan was 100% and 95%, as opposed to 33% and 97% for chest radiograph.

Role of Chest Computed Tomography in Head and Neck Cancer

“…In the initial 2 to 3 years of followup, intensive chest screening has been suggested at 4-to 6-month intervals rather than annually. 4 Chest CT is superior to radiography in sensitivity and adds little extra time and radiation dose (3-6 msv) when performed with neck CT. 10,13 However, chest CT is more expensive, and its indications vary widely as a screening tool for HNSCC.…”

Should preoperative chest computed tomography be performed in all patients with colorectal cancer?

“…Pulmonary metastases can be detected by either plain X-ray or chest computed tomography (CCT). X-ray is less sensitive than CCT (33% vs 75%) [2,[6][7][8], but lesions detected by X-ray usually have greater clinical significance. CCT can detect lung nodules under 2-3 mm in size, but in up to 30% of these cases it is not possible to determine whether these lesions are malignant [8,9].…”

Role of chest CT in staging of oropharyngeal cancer: A systematic review

“…However, it involves a considerable dose of radiation (on average 8 mSv, the equivalent of 400 chest X‐rays [CXRs]). Some centers routinely undertake chest CT in all patients with HNSCC,2–10 whereas others selectively screen those with clinical stage III or IV disease, or using other clinical criteria such as presence of nodal disease 1, 11–24. In patients with HNSCC, most chest malignancy occurs in the lung apices or mediastinal lymph nodes.…”