American Journal of Roentgenology, Vol 169, 667-671, Copyright © 1997 by American Roentgen Ray Society
The impact of routine CT of the chest on the diagnosis and management of newly diagnosed squamous cell carcinoma of the head and neck
B Reiner, E Siegel, R Sawyer, RM Brocato, M Maroney and F Hooper
Department of Radiology, University of Maryland Medical Center, Baltimore 21201, USA.
OBJECTIVE: The purpose of the study was to ascertain how often additional
malignant neoplasms are detected on CT scans of the thorax in patients with
newly diagnosed squamous cell carcinoma of the head and neck and to
determine how often these findings are evident on conventional radiographs
of the chest. SUBJECTS AND METHODS: One hundred eighty-nine patients with
newly diagnosed squamous cell carcinoma of the head and neck were
prospectively examined in a 5-year period. At the time of the initial
diagnosis, each patient underwent both chest radiography (posteroanterior
and lateral radiographs in 95%, anteroposterior in 5%) and thoracic CT to
assess the prevalence of additional primary or metastatic malignant
neoplasms of the thorax and upper abdomen. RESULTS: Of the 189 patients
studied, 66 showed a total of 73 significant abnormalities on thoracic CT
scans of which only 17 abnormalities (23%) were detected on chest
radiographs alone. Of these 66 patients, 36 (55%) were found to have one or
more primary or metastatic neoplasms. These 36 patients manifested a total
of 41 additional primary or secondary malignant neoplasms including 24
cases in which one or more pulmonary nodules were detected, six cases of
lymphadenopathy, three hepatic lesions, three bone lesions, two pleural
masses, two esophageal masses and one adrenal mass. Of these 41 malignant
tumors, 13 (32%) were synchronous primary tumors and 28 were metastases.
Only 12 (29%) of the 41 malignant tumors detected by thoracic CT were seen
on the chest radiographs. In all patients in which an additional malignant
tumor was diagnosed, clinical management was significantly affected,
resulting in a modification of the planned surgery or the addition of
chemotherapy, radiation therapy, or both. CONCLUSION: A relatively large
percentage of patients (19%) with newly diagnosed squamous cell cancer of
the head and neck was found to have additional malignant tumors, 32% of
which were synchronous primary tumors. The discovery of these additional
neoplasms had a major effect on both the therapy and the prognosis of these
patients. The combination of a relatively poor detection rate for
conventional chest radiography, with only 29% of the malignant tumors
detected on CT scans of the chest being seen on chest radiographs, and the
high prevalence of disease in this population support the routine inclusion
of thoracic CT in these patients.
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