Role of screening chest computed tomography in patients with advanced headand neck cancer

OBJECTIVE: The presence of pulmonary metastases significantly alters the tr eatment of patients with head and neck cancers, Currently, a chest radiogra ph (CXR) is used as a screening examination, although a chest CT (CCT) can detect smaller lesions. The aim of this study was to evaluate the benefit o f CCT as a screening tool in patients with newly diagnosed advanced head an d neck cancers, METHOD: New patients with stage III and IV head and neck squamous cell carc inomas were enrolled in this prospective study from August 1994 to December 1995. Twenty-five patients underwent CXR ($71) and CCT ($597) within 2 wee ks of diagnosis of the index cancer. RESULTS: In 20 patients neither the CXR nor the CCT showed any evidence of pulmonary malignancy. Two patients had normal CXRs but possible metastases on CCT. Both the pulmonary lesions resolved on follow-up evaluation, Two pa tients had suspicious lesions on CXR, 1 of whom had a normal CCT, The secon d patient underwent CT-guided biopsy which was negative for malignancy, Bot h the CXR and CCT of the final patient, who had a bronchogenic carcinoma, w ere suspicious. CONCLUSION: In 2 patients CCT detected suspicious lesions missed on CXR, al though neither revealed malignancy. Three patients with suspicious CXRs wou ld have had CCTs anyway, Thus 22 of 25 CCTs done at the additional cost of $13,314 did not add to the sensitivity of the screening for pulmonary metas tasis or second lung primary.