title: Utility of abdominal imaging to assess for liver metastasis in patients with head and neck cancer and abnormal liver function tests.
abstract: OBJECTIVE
  To determine the utility of abdominal imaging to further evaluate abnormal pre-operative liver function tests (LFTs) in patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Records of patients evaluated by the head and neck surgery service from January 2004 through December 2009 were reviewed. For patients with abnormal alkaline phosphatase, alanine transaminase, or aspartate transaminase, subsequent abdominal imaging was assessed.
  
  
  RESULTS
  Of the 862 patients with HNSCC who had documented LFTs, 109 (12.6%) had one or more abnormal values. In the same time period, LFTs were also obtained on 361 patients with benign head and neck tumors; of these, 40 (11.1%) had abnormalities. Of the 109 patients with HNSCC and abnormal LFTs, 78 (71.6%) underwent abdominal imaging (ultrasound, CT, MRI, or PET/CT). Overall, liver metastasis was demonstrated in only 1 of 109 patients with abnormal LFTs (0.92%) and in only 1 of 862 patients with HNSCC (0.12%).
  
  
  CONCLUSIONS
  While HNSCC patients rarely present with liver metastasis, they often have abnormal LFTs. Although the presence of liver metastasis can dramatically change patient management, the yield of follow-up liver imaging for all patients with elevated LFTs is exceedingly low. Thus, the use of risk-stratified abdominal imaging may be prudent and cost effective in a select group of patients in whom distant metastasis is more likely. However, characteristics of this group are difficult to define given the rarity of liver metastasis in HNSCC.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
authors: Philip G
authors: PG
authors: Chen
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
authors: Stephen S
authors: SS
authors: Schoeff
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
authors: Cara A
authors: CA
authors: Watts
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
authors: James F
authors: JF
authors: Reibel
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
authors: Paul A
authors: PA
authors: Levine
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
authors: David C
authors: DC
authors: Shonka
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA. Electronic address: mark.jameson@virginia.edu.
authors: Mark J
authors: MJ
authors: Jameson
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging / Q000473:pathology; D000410:Alanine Transaminase / Q000097:blood*; D000469:Alkaline Phosphatase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000175:diagnosis / Q000556:secondary*; D003952:Diagnostic Imaging / Q000379:methods / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000097:blood / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000201:enzymology / Q000556:secondary; D008279:Magnetic Resonance Imaging; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase