title: CT staging and surveillance of the thorax in patients with newly diagnosed and recurrent squamous cell carcinoma of the head and neck: is it necessary?
abstract: The detection of distant metastases or synchronous primary tumours at initial presentation, or at recurrence in patients with head and neck squamous cell carcinoma (HNSCC), frequently alters the selection of therapy in these patients. A number of series report appreciably high rates for these lesions. This study evaluated 108 computed tomography (CT) scans and chest radiographs (CXR) of the thorax, in 80 patients presenting with HNSCC over a 4 year period. There were three clinical settings; (a) at original diagnosis n = 61, (b) clinical evidence of local/regional recurrence n = 19 (c) suspicion of recurrence due to neck symptomatology n = 28. CT thorax detected two out of 61 (3%) distant metastases at the initial diagnosis stage (both were either stage III or IV) and one out of 19 (5%) patients evaluated at the time of loco/regional recurrence. CXR failed to reveal evidence of pulmonary metastases in the two patients at initial diagnosis stage, but correctly identified pulmonary metastases in the loco-regional recurrence patient. There was no thoracic malignancy detected in the surveillance CT scans, and no synchronous second primary tumour detected during the study. CT is known to be more sensitive than conventional CXR in detecting thoracic pathology in HNSCC patients, however, we feel CT is of limited value in stage I or II disease. We no longer carry out routine staging CT scans of the thorax in patients presenting with stage I or II HNSCC, or with neck symptomatology with no clinical evidence of recurrence.
authors.affiliation: South Infirmary/Victoria Hospital Ltd, Old Blackrock rd, Cork, Ireland. fglynn@rcsi.ie
authors.forename: Fergal
authors.initials: F
authors.lastname: Glynn
authors.forename: Sinead
authors.initials: S
authors.lastname: Brennan
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Leary
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D014057:Tomography, X-Ray Computed