title: Screening for distant metastases in patients with head and neck cancer: what is the current clinical practice?
abstract: OBJECTIVE
  The detection of distant metastases during screening influences the choice of treatment in patients with head and neck squamous cell carcinoma (HNSCC). There is no consensus on the diagnostic technique that has to be used nor on the subgroup of HNSCC patients that may benefit from screening.
  
  
  METHODS
  Questionnaire on current practice concerning the diagnostic work-up in HNSCC patients for screening for distant metastases.
  
  
  METHODS
  Investigators in the 12 otolaryngology / head and neck and seven oromaxillofacial departments treating head and neck cancer in the Netherlands.
  
  
  RESULTS
  The response rate was 100%. Indications for screening were cervical lymph node metastases (63%), mutilating surgery (58%), locoregional recurrence (47%), advanced T-stage (32%), second primary tumour (21%). Diagnostic techniques routinely used for screening besides chest X-ray were chest CT (84%), liver ultrasound (53%), liver CT (16%) and bone scintigraphy (42%). Forty-two per cent of the clinicians were not satisfied with the current methods of screening.
  
  
  CONCLUSIONS
  This survey shows a substantial variation in indications and diagnostic techniques used for screening for distant metastases between the major institutions treating head and neck cancer in the Netherlands. There is a need for guidelines for screening for distant metastases in patients with head and neck cancer.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Brouwer
authors.forename: R
authors.initials: R
authors.lastname: Bree
authors.forename: O S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: J A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: J A
authors.initials: JA
authors.lastname: Castelijns
authors.forename: C R
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D001842:Bone and Bones / Q000000981:diagnostic imaging; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis / Q000175:diagnosis; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D013902:Radiography, Thoracic; D011877:Radionuclide Imaging; D014463:Ultrasonography