Proposal of standardization on screening tests for detection of distant metastases from head and neck cancer

A standardized approach to screening for distant metastases must be flexibl e. This reflects the fact that the issues involved have not been adequately studied to allow evidence-based recommendations. Effective and responsible application of screening for distant metastasis would improve our ability to council patients regarding important therapeutic decisions. It would als o have important consequences on healthcare economics. Screening recommenda tions should reflect the stage of the primary tumor and the histologic cell type because these two parameters most clearly correlate with the risk for distant metastases. The most commonly encountered distant metastases are p ulmonary. The most sensitive validated screening technique is just computed tomography (CT). Advanced technologies such as simultaneous positron emiss ion tomography/CT may replace these prior technologies in the near future. Recommendations for routine screening following curative treatment are subj ective at this time. Careful history and physical examination remains the b asis for the follow-up evaluation. The sensitivity and cost effectiveness o f imaging studies in this setting remains unstudied and contentious. Copyri ght (C) 2001 S.Karger AG, Basel.