Is routine triple endoscopy for head and neck carcinoma patients necessary in light of a negative chest computed tomography scan?
BACKGROUND
The objective of the current study was to analyze the results obtained by triple endoscopy during the initial evaluation of a primary carcinoma of the head and neck.


METHODS
A total of 487 patients with a squamous cell carcinoma of the head and neck was studied. None of the patients had evidence of metastasis or a second primary tumor on the thoracic computed tomography (CT) scan or chest X-ray. All patients underwent a triple endoscopy including nasopharyngoscopy, laryngoscopy, pharyngoscopy, bronchoscopy, and esophagoscopy.


RESULTS
A synchronous primary invasive carcinoma of the lung and esophagus was diagnosed in 5 patients (1%) and 10 patients (2%), respectively. In addition, nine lesions were considered to be a regional extension of the primary tumor to the esophagus, and nine in situ carcinomas were observed. It is interesting to note that a significant correlation was found between the risk of a second synchronous esophageal carcinoma and the initial location of the primary head and neck carcinoma (P = 0.002, chi-square test). Esophageal carcinoma was observed in 1.3% of the patients with an oropharyngeal tumor, 2% of the patients with a laryngeal tumor, none of the patients with a tumor of the oral cavity, and 9.2% of the patients with a hypopharyngeal tumor.


CONCLUSIONS
The role of bronchoscopy and esophagoscopy in the presence of a normal thoracic CT scan has been questioned because of the relatively low incidence of a second esophageal and/or lung primary tumor. Nonetheless, based on the same incidence criterion, it appears reasonable to schedule a routine esophagoscopy for those patients with a squamous cell carcinoma of the hypopharynx.
Guardiola
Emmanuel
E
Department of Oncology, CHU J. Minjoz, Besancon, Cedex, France. eguardiola@chu-besancon.fr
Pivot
Xavier
X
Dassonville
Olivier
O
Poissonnet
Gilles
G
Marcy
Pierre-Yves
PY
Otto
Josiane
J
Poudenx
Michel
M
Francois
Eric
E
Bensadoun
René-Jean
RJ
Thyss
Antoine
A
Demard
François
F
Schneider
Maurice
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed