Efficacy of radiologic screening for distant metastases and second primaries in newly diagnosed patients with head and neck cancer.
OBJECTIVE
Detection of distant metastases and second primary tumors in newly diagnosed patients with head and neck cancer has usually a major effect on prognosis but does not always influence clinical management. This must be considered when radiologic screening investigations are used. The present study particularly evaluates how often additional neoplastic lesions detected by screening had an impact on therapy.


METHODS
The authors conducted a single-institution retrospective analysis.


METHODS
The medical records of 260 patients with newly diagnosed squamous cell carcinoma of the head and neck treated between 1999 and 2002 were retrospectively analyzed. Before therapy, all patients had undergone screening by computed tomography scan of the chest, abdominal ultrasound, and bone scintigraphy.


RESULTS
Screening investigations identified 16 patients (6.2%) with distant metastases and six patients (2.3%) with simultaneous second primaries. Chest computed tomography scan detected 20 neoplastic lesions; abdominal ultrasound and bone scintigraphy each detected 2. Three findings of distant metastases proved to be false-positive during follow up. Of the 22 patients with positive screening results, clinical management was affected in 13 (59.1%). Twelve were originally scheduled for curative surgery and 10 had chest abnormalities.


CONCLUSIONS
Chest computed tomography scan was the most effective screening investigation, which should be routinely used whenever curative surgery of head and neck cancer is planned. Abdominal ultrasound and bone scintigraphy may sometimes be valuable before extensive surgical treatment of far advanced disease. In patients scheduled for primary radiotherapy, radiologic screening had hardly any consequence and should be confined to conventional x-ray of the chest.
Jäckel
Martin C
MC
Department of Otorhinolaryngology, Hospital of Darmstadt, Darmstadt, Germany. martin.jaeckel@surfeu.de
Reischl
Andrea
A
Huppert
Peter
P
D000005:Abdomen / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D003952:Diagnostic Imaging; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D010347:Patient Care Planning; D011379:Prognosis; D013902:Radiography, Thoracic; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography