Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T06:27:08.362Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of X-ray and computed tomography screening for assessing pulmonary involvement in patients with head and neck squamous cell carcinoma

Published online by Cambridge University Press:  07 January 2008

S C L Leong ,
F Javed ,
S Elliot  and
S Mortimore
S C L Leong*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Derby Royal Infirmary, UK
F Javed
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Derby Royal Infirmary, UK
S Elliot
Affiliation:
Department of Radiology, Derby Royal Infirmary, UK
S Mortimore
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Derby Royal Infirmary, UK
*
Address for correspondence: Mr S C Leong, 34A Upper Parliament St, Liverpool L8 1TE, UK. Fax: +44 124 436 6423 E-mail: lcheel@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To evaluate the benefits of chest computed tomography and X-ray as screening tools in patients with newly diagnosed head and neck squamous cell carcinoma, to determine the incidence of lung metastases or synchronous pulmonary lesions, and to evaluate factors associated with positive radiological findings.

Design:

Five-year, retrospective survey of all newly diagnosed cases of head and neck squamous cell carcinoma.

Results:

We included 102 patients (63 men and 39 women), with a mean age of 67 years (range 33–91 years). The incidence of pulmonary involvement was 17 per cent. The sensitivity and specificity of computed tomography were 100 and 89.8 per cent, respectively. For chest X-ray, the sensitivity was 35.7 per cent and the specificity 92.7 per cent. The accuracy of computed tomography was 91.5 per cent and that of chest X-ray 83.1 per cent. There was a clear correlation between higher nodal stage and larger tumour with the development of distant metastases. In patients with a positive chest computed tomography scan, 86 per cent had T3 or T4 tumours, in contrast to 38 per cent of those with a negative chest scan (p < 0.05). In addition, 71 per cent of patients with positive findings had N2 or N3 nodal disease, compared with 29 per cent of those with negative findings (p < 0.05).

Conclusion:

There is currently no consensus on the use of chest X-ray and computer tomography for screening newly diagnosed cases of head and neck squamous cell carcinoma. We recommend routine scanning of high-staged head and neck squamous cell carcinoma. The National Institute of Health and Clinical Excellence guidelines should be reappraised.

Keywords

Computer TomographyHead and Neck CancerScreening
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 9 , September 2008 , pp. 961 - 966
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Ferlito, A, Shaha, AR, Silver, CE, Rinaldo, A, Mondin, V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001;63:602–7Google Scholar
2 de Bree, R, Deurloo, EE, Snow, GB, Leemane, CR. Screening for distant metastases in patients with head and neck cancer. Laryngoscope 2000;110:397–401CrossRefGoogle ScholarPubMed
3 Brouwer, J, Bree, R, Hoekstra, OS, Langendijk, JA, Casterlijns, JA, Leemans, CR. Screening for distant metastases in patients with head and neck cancer: what is the current clinical practice? Clin Otolaryngol 2005;30:438–43Google Scholar
4 Houghton, DJ, Hughes, ML, Garvey, C, Beasley, NJP, Hamilton, JW, Gerlinger, I et al. Role of chest CT scanning in the management of patients presenting with head and neck cancer. Head Neck 1998;20:614–183.0.CO;2-J>CrossRefGoogle ScholarPubMed
5 National Institute for Clinical Excellence. Improving Outcomes in Head and Neck Cancers – The Manual. London: National Institute for Clinical Excellence, 2004Google Scholar
6 Warner, GC, Cox, GJ. Evaluation of chest radiography versus chest computed tomography in screening for pulmonary malignancy in advanced head and neck cancer. J Otolaryngol 2003;32:107–9Google Scholar
7 Arunachalam, PS, Putnam, G, Jennings, P, Messersmith, R, Robson, AK. Role of computerized tomography (CT) scan of the chest in patients with newly diagnosed head and neck cancers. Clin Otolaryngol Allied Sci 2002;27:409–11Google Scholar
8 Tan, L, Greener, CC, Seikaly, H, Rassekh, CH, Calhoun, KH. Role of screening chest computed tomography in patients with advanced head and neck cancer. Otolaryngol Head Neck Surg 1999;120:689–92Google Scholar
9 Houghton, DJ, McGarry, G, Stewart, I, Wilson, JA, McKenzie, K. Chest computerised tomography scanning in patients presenting with head and neck cancer. Clin Otolaryngol Allied Sci 1998;23:348–50CrossRefGoogle ScholarPubMed
10 Nillsen, ELK, Murthy, P, McClymont, L, Denholm, S. Radiological staging of the chest and abdomen in head and neck squamous cell carcinoma – are computed tomography and ultrasound necessary? J Laryngol Otol 1999;113:152–4Google Scholar
11 Troell, RJ, Terris, DJ. Detection of metastases from head and neck cancers. Laryngoscope 1995;105:247–50Google Scholar
12 Kesti-Santti, H, Markkola, ATO, Makitie, AA, Back, LJJ, Atula, TS. CT of the chest and abdomen in patients with newly diagnosed head and neck squamous cell carcinoma. Head Neck 2005;27:909–14Google Scholar
13 Loh, KS, Brown, DH, Baker, JT, Gilbert, RW, Gullane, PJ, Irish, JC. A rational approach to pulmonary screening in newly diagnosed head and neck cancer. Head Neck 2005;27:990–4Google Scholar
14 Mercader, VP, Gatenby, RA, Mohr, RM, Fisher, MS, Caroline, DF. CT surveillance of the thorax in patients with squamous cell carcinoma of the head and neck: a preliminary experience. J Comput Assist Tomogr 1997;21:412–17Google Scholar
15 Gregoire, V, Bol, A, Geets, X, Lee, J. Is PET-based treatment planning the new standard in modern radiotherapy? The head and neck paradigm. Semin Radiat Oncol 2006;16:232–8CrossRefGoogle ScholarPubMed
16 Pauleit, D, Zimmerman, A, Stoffels, G, Bauer, D, Risse, J, Fluss, MO et al. 18F-FET PET compared with 18F-FDG PET and CT in patients with head and neck cancer. J Nucl Med 2006;47:256–61Google Scholar
17 Choi, JY, Lee, KS, Kwon, OJ, Shim, YM, Baek, CH, Park, K et al. Improved detection of second primary cancer using integrated (18F) fluorodeoxyglucose positron emission tomography and computer tomography for initial tumour staging. J Clin Oncol 2005;23:7654–9Google Scholar
18 Jeong, HS, Baek, CH, Son, YI, Ki Chung, M, Kyung Lee, D, Young Choi, J et al. Use of integrated (18)F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma. Head Neck 2007;29:203–10Google Scholar