ROLE OF CHEST CT SCANNING IN THE MANAGEMENT OF PATIENTS PRESENTING WITH HEAD AND NECK-CANCER

Background. The detection of synchronous tumors, whether they be secon d primaries or distant metastases, in patients with head and neck carc inoma drastically affects prognosis and may alter management. Computer ized tomographic (CT) scanning of the chest is an effective screening investigation in this group of patients, both in the detection of sync hronous second primary tumors, the incidence of which in this study is 15%, and for accurate staging of metastatic pulmonary disease. The in cidence of synchronous tumors in patients who are initially seen with head and neck squamous cell carcinoma (HNSCC) has been reported in lar ge retrospective studies as being between 1% and 3%. These may be eith er second primary tumors or metastases, and the lung is the commonest site for both. Methods. Eighty-one head and neck cancer patients (67 p rimary and 14 secondary referrals) treated at the Royal Liverpool Univ ersity Hospital between 1994 and 1996 underwent CT scanning of the che st with ultrasound of the liver as part of their routine staging. The results were compared with standard chest x-rays also performed in eac h patient. Results. Fourteen patients had pulmonary tumors detected on the chest CT scan. In 67 patients, the scan was negative. Patients wi th negative scans tended not to have neck node metastases (64%), where as patients with positive scans were much more likely to have neck nod e metastases with negative necks present in only 36% of patients. Wher e multivariate analysis was carried out. there was a correlation betwe en neck node metastases and positive CT scans of the chest (estimate = 0.5755, standard error = 0.3066, X-1(2) = 6.73, p .047). The sensitiv ity of chest x-ray compared with CT scan was only 21% and the specific ity 99%. The positive predictive value of a chest x-ray was 75% and th e negative predictive value 86%. Intra-abdominal lesions were detected in two patients, one in the liver and one in the adrenal gland. In th e latter patient. this was an isolated lesion, but in the former, the chest scan was also positive. In the 67 patients, who were initially s een at the Royal Liverpool Hospital (primary referrals), the incidence of synchronous tumors was 15%. Conclusions. Synchronous tumors, wheth er they be second primary tumors or distant metastases, are more commo n in patients initially seen with head and neck cancer than is realize d, their incidence being significantly higher in those patients with c ervical metastases. Computerized tomographic scanning of the chest is a more effective screening investigation than chest x-ray in this grou p of patients and is now used routinely in our department prior to und ertaking major head and neck surgery. (C) 1998 John Wiley & Sons, Inc.