Ms. Benninger et al., SYMPTOM-DIRECTED SELECTIVE ENDOSCOPY AND COST-CONTAINMENT FOR EVALUATION OF HEAD AND NECK-CANCER, Head & neck, 15(6), 1993, pp. 532-536
Panendoscopy is commonly used for diagnosing synchronous primary neopl
asms of the head and neck, although the yield and cost effectiveness h
as been questioned. To compare symptom-directed selective endoscopy to
panendoscopy, 100 consecutive patients with newly diagnosed and untre
ated squamous cell carcinoma were prospectively evaluated. Symptoms we
re used to select which studies might have been performed to discover
synchronous primary lesions. All patients were subsequently evaluated
with chest x-ray, barium esophagram, direct pharyngolaryngoscopy, esop
hagoscopy, and bronchoscopy with bronchial washings. Seven synchronous
primary neoplasms were discovered in six patients with one patient ha
ving three separate tumors. There were five synchronous pharyngeal and
one oral cavity neoplasms with two of the pharyngeal tumors being asy
mptomatic. Two primary cervical esophageal tumors and one synchronous
esophageal tumor were found in three patients all of whom had symptoms
of dysphagia and odynophagia. Two pulmonary metastasis were discovere
d by chest x-ray in patients with normal bronchoscopies with bronchial
washings. Selective symptomatic evaluations would have resulted in on
e-third savings in total cost and would have minimized excessive proce
dures and potential morbidity. Direct pharyngolaryngoscopy and chest x
-rays are recommended for patients with squamous cell carcinoma of the
head and neck but esophagoscopy, esophagogram, and bronchoscopy might
be reserved for patients with associated symptoms. Bronchial washings
are not recommended. (C) 1993 John Wiley & Sons, Inc.