title: Management of pulmonary nodules in head and neck cancer patients - Our experience and interpretation of the British Thoracic Society Guidelines.
abstract: BACKGROUND
  and purpose of the study: The frequency of lung nodules in the head and neck cancer population is unknown, currently the only guidance available recommends following local policy. The aim of this study was to determine the incidence of pulmonary nodules in our head and neck cancer group and interpret the recently updated British Thoracic Society (BTS) Lung Nodule Guidelines in a head and neck cancer setting.
  
  
  METHODS
  100 patients were diagnosed with head and neck cancer between July 2013-March 2014, clinico-pathological, demographic and radiological data was extracted from the electronic records. Images with lung findings were re-reviewed by a single consultant radiologist for patients with lung pathology on the initial staging CT report.
  
  
  RESULTS
  Twenty patients (20%) had discreet pulmonary findings on CT. Eleven (11%) had lung nodules, 6 (6%) had lesions suspicious for metastasis and 3 (3%) had co-incidental bronchogenic primary cancers. These patients were re-imaged between 6 and 18 months and in 1 patient the previously identified 7 mm nodule had progressed to 16 mm at 1 year. There was no set follow up imaging protocol used.
  
  
  CONCLUSIONS
  The MDT in NHS Lothian has reviewed the BTS guidance and now has a local policy for the management of lung nodules in head and neck cancer patients. Lung Nodules in the head and neck cancer population are common >10%. Higher risk patients with larger nodules should be risk assessed with validated assessment tools. PET-CT has a place in the assessment of lung nodules when risk of malignancy is high.
authors.affiliation: ENT Department Edinburgh, Lauriston Building, UK. Electronic address: richard.green14@nhs.net.
authors.forename: Richard
authors.initials: R
authors.lastname: Green
authors.affiliation: ENT Department Edinburgh, Lauriston Building, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: King
authors.affiliation: Radiology Department, St Johns Hospital, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Reid
authors.affiliation: Radiology Department, Royal Infirmary of Edinburgh, UK.
authors.forename: John T
authors.initials: JT
authors.lastname: Murchison
authors.affiliation: ENT Department Edinburgh, Lauriston Building, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Evans
authors.affiliation: ENT Department Edinburgh, Lauriston Building, UK.
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D017410:Practice Guidelines as Topic; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Head and neck cancer; Imaging; Pulmonary nodules