title: Observing stage-shifts in head and neck squamous cell carcinoma from initial clinical outpatient staging to definite clinical tumour board staging using radiological and endoscopical investigations: will less do?
abstract: OBJECTIVE
  Staging head and neck squamous cell carcinoma usually is initiated in the outpatient department (OPD) using patient history and physical examination. To reach consensus on stage and therapy, imaging and panendoscopy are more or less routinely applied as additional staging tests. Staging results from the outpatient department were evaluated for tumour and neck stage. We investigated in which situations additional staging tests are needed.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Head and Neck Oncology Group, University Medical Centre.
  
  
  METHODS
  Of 341 patients, initial staging results from the outpatient department were compared with the ultimate staging results from the tumour board review, which provides the basis for decisions on therapy.
  
  
  METHODS
  Tumour stage and neck stage migrations during this staging tract.
  
  
  RESULTS
  In staging head and neck tumours are squamous cell carcinomas, additional staging tests like imaging and/or panendoscopy remain necessary to evaluate the primary tumour stage. Average accuracies of T-staging in oral cavity, pharynx and larynx only amount to 71%, 47% and 61%, respectively. For T1N0 and T2N0 oral cavity tumours, neck assessment in the outpatient department was accurate in 100% (95% CI: 91-100%) and 93% (95% CI: 80-98%), respectively. In the larynx group, this was 100% (95% CI: 91-100%) and 97% (95% CI: 86-100%), respectively.
  
  
  CONCLUSIONS
  For oral cavity and laryngeal tumours staged as T1-2N0 in the outpatient department, we concluded that the outpatient department staging is highly predictive of the final pre-treatment staging. In these cases, computer tomography and/or MRI remain a necessity but additional ultrasound with or without fine needle aspiration cytology can be omitted. In our institution, this would have resulted in a 46% reduction in ultrasound procedures. If T-stage is upgraded during imaging or panendoscopy, additional staging tests for N-stage should still be considered.
authors.affiliation: Department of Otorhinolaryngology Head and Neck, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands. w.braunius@umcutrecht.nl
authors.forename: W W
authors.initials: WW
authors.lastname: Braunius
authors.forename: C H
authors.initials: CH
authors.lastname: van Gils
authors.forename: A J W P
authors.initials: AJ
authors.lastname: Rosenberg
authors.forename: G J
authors.initials: GJ
authors.lastname: Hordijk
authors.forename: K G M
authors.initials: KG
authors.lastname: Moons
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010045:Outpatients; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*