NEW YORK (Reuters Health) - Chest computed tomography (CT) is recommended for high-risk patients with head and neck cancer, according to findings published in the October issue of the Archives of Otolaryngology-Head and Neck Surgery.

"The development of a malignant neoplasm of the lung, including distant metastasis and second primary cancer, is an important factor that limits the survival of patients with head and neck squamous cell carcinoma (HNSCC)," Dr. Shyh-Kuan Tai, of Taipei Veterans General Hospital, Taiwan, and colleagues explain. "Because the presence of a malignant neoplasm of the lung may alter the case management, evaluation of the chest condition is important for patients with HNSCC at the initial diagnosis and during the follow-up period."

The researchers retrospectively examined the role of chest CT in patients with HNSCC. Included in the study were 270 chest CT scans performed in 192 patients during a 42-month period. The CT scans were categorized as new cases, follow-up cases, or recurrent cases. The initial results of the scans were classified as normal or abnormal.

Of the 270 CT scans, 79 (29.3%) were considered abnormal; 54 were malignant neoplasms and 25 were indeterminate lesions. A significantly higher proportion of scans were classified as abnormal in the follow-up case group than in the new case group (44.2% versus 14.2%, respectively; p < 0.001). Abnormal scans were comparable between the follow-up case group and the recurrent case group.

Of 15 indeterminate scans with small (<1 cm) solitary pulmonary nodules, 10 (66.7%) showed disease progression on subsequent follow-up scans, which changed the diagnosis to malignant neoplasm of the lung.

"Intensified evaluation and management are mandatory for indeterminate small solitary pulmonary nodules because of the high rate of malignant neoplasms," the investigators advise.

They note that 63 of the 192 patients with HNSCC (32.8%) eventually developed a malignant neoplasm of the lung.

Arch Otolaryngol Head Neck Surg 2008;134:1050-1054.

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