title: Symptom-directed selective endoscopy: long-term efficacy.
abstract: BACKGROUND
  Synchronous primary neoplasms have been encountered in some patients with mucosal squamous cell carcinoma of the head and neck. Routine panendoscopy along with various radiological tests have been advocated to identify these potential tumors. In 1993, we originally described symptom-directed, selective endoscopy as an efficient and cost-effective means to evaluate patients to identify synchronous primary neoplasms.
  
  
  OBJECTIVE
  To review the ultimate success rate of symptom-directed, selective endoscopy in that initial cohort of patients and the success of the program longitudinally in clinical practice over the intervening 6 years.
  
  
  METHODS
  The status of the original 100 patients who participated in the selective endoscopy study were reviewed at least 6 months after the original procedure. A statistically significant random sample of 101 subsequent patients who had at least 6 months' follow-up or until their death were reviewed.
  
  
  RESULTS
  No additional primary, mucosal head and neck, esophageal, or pulmonary cancers were identified in the surviving original cohort of patients suggesting that the selective endoscopy identified all synchronous tumors. Sixteen metachronous primary cancers were identified between 12 and 70 months after the initial evaluation. Eight synchronous primary cancers were identified in the new cohort using symptom-directed evaluation, direct laryngopharyngoscopy, and chest x-ray films. No additional tumors were detected within 6 months.
  
  
  CONCLUSIONS
  Symptom-directed, selective endoscopy seems to be an effective alternative to routine panendoscopy in identifying synchronous primary cancers.
authors.affiliation: Department of Otolarynology-Head and Neck Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA. Mbenning@HFHS.org
authors.forename: M S
authors.initials: MS
authors.lastname: Benninger
authors.forename: A
authors.initials: A
authors.lastname: Shariff
authors.forename: K
authors.initials: K
authors.lastname: Blazoff
mesh_terms: D015331:Cohort Studies; D004724:Endoscopy; D006801:Humans; D007828:Laryngoscopy; D008137:Longitudinal Studies; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000401:mortality; D010039:Otorhinolaryngologic Neoplasms / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate