title: Screening for distant metastases in patients with head and neck cancer: is chest computed tomography sufficient?
abstract: OBJECTIVE
  The detection of distant metastases during screening influences the choice of treatment in patients with head and neck squamous cell carcinoma. A previous study in the authors' institution showed that chest computed tomography (CT) scan was the most important screening technique. Different clinical risk factors in patients with head and neck squamous cell carcinoma for the development of distant metastases were identified.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  To evaluate the authors' diagnostic strategy, the accuracy of screening for distant metastases with chest CT in 109 consecutive patients with head and neck squamous cell carcinoma with risk factors between 1997 and 2000 was retrospectively analyzed.
  
  
  RESULTS
  Preoperative screening with CT revealed 20 patients (18%) with lung metastases and 1 liver metastasis. Despite negative screening with chest CT, 9 (11%) patients developed distant metastases within 12 months during follow-up. Sensitivity of the chest CT was 73%; the specificity was 80%.
  
  
  CONCLUSIONS
  Although chest CT frequently detects distant metastases, there seems to be a need for a more sensitive and whole-body screening technique.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jolijn
authors.initials: J
authors.lastname: Brouwer
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Richard P
authors.initials: RP
authors.lastname: Golding
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008403:Mass Screening; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed